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    All purulence is local - epidemiology and management of skin and soft tissue infections in three urban emergency departments

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    Authors
    Merritt, Chris
    Haran, John P
    Mintzer, Jacob
    Stricker, Joseph
    Merchant, Roland C.
    UMass Chan Affiliations
    Department of Emergency Medicine
    Document Type
    Journal Article
    Publication Date
    2013-12-20
    Keywords
    Skin and soft tissue infections
    Antibiotic resistance
    Antimicrobial stewardship
    Bacterial Infections and Mycoses
    Clinical Epidemiology
    Emergency Medicine
    
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    Abstract
    BACKGROUND: Skin and soft tissue infection (SSTIs) are commonly treated in emergency departments (EDs). While the precise role of antibiotics in treating SSTIs remains unclear, most SSTI patients receive empiric antibiotics, often targeted toward methicillin-resistant Staphylococcus aureus (MRSA). The goal of this study was to assess the efficiency with which ED clinicians targeted empiric therapy against MRSA, and to identify factors that may allow ED clinicians to safely target antibiotic use. METHODS: We performed a retrospective analysis of patient visits for community-acquired SSTIs to three urban, academic EDs in one northeastern US city during the first quarter of 2010. We examined microbiologic patterns among cultured SSTIs, and relationships between clinical and demographic factors and management of SSTIs. RESULTS: Antibiotics were prescribed to 86.1% of all patients. Though S. aureus (60% MRSA) was the most common pathogen cultured, antibiotic susceptibility differed between adult and pediatric patients. Susceptibility of S. aureus from ED SSTIs differed from published local antibiograms, with greater trimethoprim resistance and less fluoroquinolone resistance than seen in S. aureus from all hospital sources. Empiric antibiotics covered the resultant pathogen in 85.3% of cases, though coverage was frequently broader than necessary. CONCLUSIONS: Though S. aureus remained the predominant pathogen in community-acquired SSTIs, ED clinicians did not accurately target therapy toward the causative pathogen. Incomplete local epidemiologic data may contribute to this degree of discordance. Future efforts should seek to identify when antibiotic use can be narrowed or withheld. Local, disease-specific antibiotic resistance patterns should be publicized with the goal of improving antibiotic stewardship.
    Source
    Merritt C, Haran JP, Mintzer J, Stricker J, Merchant RC. All purulence is local - epidemiology and management of skin and soft tissue infections in three urban emergency departments. BMC Emerg Med. 2013 Dec 20;13:26. doi:10.1186/1471-227X-13-26. Link to article on publisher's site
    DOI
    10.1186/1471-227X-13-26
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/30089
    PubMed ID
    24359038
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    Rights
    Copyright 2013 Merritt et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
    ae974a485f413a2113503eed53cd6c53
    10.1186/1471-227X-13-26
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    UMass Chan Faculty and Researcher Publications
    Emergency Medicine Publications

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