1321. Adherence to IDSA Guidelines for the Treatment of Skin and Soft-tissue Infections
Session: Oral Abstract Session: Clinical Management of Infectious Disease
Saturday, October 20, 2012: 11:15 AM
Room: SDCC 26 AB
Background:   Community-acquired methicillin-resistant Staphylococcus aureus(MRSA) is the most common cause of skin and soft tissue infections (SSTI).  According to 2011 IDSA clinical guidelines, the majority of healthy patients with uncomplicated cutaneous abscess do not require antibiotic therapy after incision and drainage (I&D); when empiric antibiotics are given, MRSA coverage should be included; coverage for streptococcal infection is not necessary.

Objectives:To determine adherence and describe non-adherence with clinical guidelines in the emergency department (ED) after dissemination of IDSA practice guidelines. 

Methods: Prospective enrollment of adults ≥18y with cutaneous abscess receiving I&D in two inner-city academic EDs with no history of prior treatment for the same abscess.  Patients were randomized to a rapid molecular diagnostic test result (GeneXpert® MRSA/SA SSTI assay) versus standard of care.  Clinical and demographic characteristics were collected via structured data form and chart abstraction was performed for verification.   Antibiotic choice and duration was compared to IDSA guidelines, taking into account the rapid diagnostic result for test patients. 

Results: Of 119 enrolled patients, 74% received antibiotics, and 61% received treatment that adhered to IDSA guidelines.  Guideline adherence was not significantly associated with age, gender, race, prior hospitalization, prior history of abscess, or insurance type.  Over half (51%) of the nonadherence cases were attributable to unnecessary antibiotics.  Ten patients (22%) did not receive antibiotics when indicated.   Of 74 patients who either had documented MRSA or unknown MRSA status with an indication to receive antibiotics, 14% received a cephalosporin alone or in combination in contradiction to current guidelines.

Conclusion: Patient factors were not associated with adherence to guidelines for the management of cutaneous abscess.  Of the 46 patients where clinicians did not adhere to IDSA guidelines, the most common reasons were unnecessary antibiotic use and prescribing a cephalosporin.  Further study should be undertaken to address antibiotic overuse and misuse in this population.

Larissa May, MD, MSPh1, Elisabeth Dissen1, Catherine Zatorski1, Andrea Dugas, MD2, Chase McCann, MSPh3, Tiffany Saavedra2, Jeanne Jordan, PhD3 and Richard Rothman, MD, PhD4, (1)Emergency Medicine, The George Washington University, Washington, DC, (2)Emergency Medicine, The Johns Hopkins University, Baltimore, MD, (3)Epidemiology and Biostatistics, The George Washington University, Washington, DC, (4)Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

Disclosures:

L. May, Cepheid, Inc.: Collaborator, Research support

E. Dissen, None

C. Zatorski, None

A. Dugas, Cepheid: Collaborator, Research support

C. McCann, None

T. Saavedra, None

J. Jordan, None

R. Rothman, Cepheid: Collaborator and Consultant, Consulting fee and Research support

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 17th with the exception of research findings presented at the IDWeek press conferences.