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  • 标题:All purulence is local – epidemiology and management of skin and soft tissue infections in three urban emergency departments
  • 本地全文:下载
  • 作者:Chris Merritt ; John P Haran ; Jacob Mintzer
  • 期刊名称:BMC Emergency Medicine
  • 印刷版ISSN:1471-227X
  • 电子版ISSN:1471-227X
  • 出版年度:2013
  • 卷号:13
  • 期号:1
  • 页码:26
  • DOI:10.1186/1471-227X-13-26
  • 语种:English
  • 出版社:BioMed Central
  • 摘要:

    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.

  • 关键词:Skin and soft tissue infections; Antibiotic resistance; Antimicrobial stewardship
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