Failure of Emergency Department Observation Unit Treatment for Skin and Soft Tissue Infections

Mistry, Rakesh D.; Hirsch, A.; Woodford, Ashley L.; Lundy, Megan

doi:10.1016/j.jemermed.2015.02.007

Cited by 7 publications

(5 citation statements)

References 31 publications

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“…Other studies have evaluated failed treatment of SSTIs but they have not specifically looked at the outcomes among those with US negative for abscess. 12,13 In our study, 28% of patients with radiology interpretation of "negative US of the buttock or perineum for abscess" went on to have a drainage culture collected within 48 hours; most (54%) of these cultures were obtained within 4 hours of the initial US. One pediatric study that reviewed treatment failure rates in 192 children with SSTIs reported that 4% of those with a clinical diagnosis of cellulitis went on to have an I&D procedure; however, in that study only in a minority of patients was an initial US obtained.…”

Section: Discussionmentioning

confidence: 66%

“…One pediatric study that reviewed treatment failure rates in 192 children with SSTIs reported that 4% of those with a clinical diagnosis of cellulitis went on to have an I&D procedure; however, in that study only in a minority of patients was an initial US obtained. 12 In an adult study reviewing treatment response rates in 34 patients with cellulitis, 9% developed purulent fluid collections on US within 4 days of presentation. 14 In our study population, patients with a SOA were more likely to be admitted, which suggests that physicians may have had a clinical suspicion for treatment failure that warranted admission and monitoring for clinical improvement before discharge.…”

Section: Discussionmentioning

confidence: 99%

“…This is the first study to our knowledge that describes the rate of SOA. Other studies have evaluated failed treatment of SSTIs but they have not specifically looked at the outcomes among those with US negative for abscess 12,13 …”

Section: Discussionmentioning

confidence: 99%

“…In our study, 28% of patients with radiology interpretation of “negative US of the buttock or perineum for abscess” went on to have a drainage culture collected within 48 hours; most (54%) of these cultures were obtained within 4 hours of the initial US. One pediatric study that reviewed treatment failure rates in 192 children with SSTIs reported that 4% of those with a clinical diagnosis of cellulitis went on to have an I&D procedure; however, in that study only in a minority of patients was an initial US obtained 12 . In an adult study reviewing treatment response rates in 34 patients with cellulitis, 9% developed purulent fluid collections on US within 4 days of presentation 14 .…”

Section: Discussionmentioning

confidence: 99%

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Sonographically Occult Abscesses of the Buttock and Perineum in Children

Nelson

Kaplan²,

Bellah³

et al. 2017

Pediatr Emer Care

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Background: Ultrasound (US) is used to differentiate abscess from cellulitis. At our institution, we observed children who had purulent fluid obtained after a negative abscess US. We sought to determine the incidence of sonographically occult abscess (SOA) of the buttock and perineum, and identify associated clinical and demographic characteristics.Methods: Retrospective chart review including children younger than 18 years old presenting to pediatric emergency department with soft tissue infection of the buttock or perineum and diagnostic radiology US read as negative for abscess. We defined SOA as wound culture growing pathogenic organism obtained within 48 hours of the US. Clinical and demographic characteristics included age, sex, race, ethnicity, fever, history of spontaneous drainage, duration of symptoms, previous methicillin resistant Staphylococcus aureus (MRSA) infection, or previous abscess. We used univariate and multivariate logistic regression to assess correlation between these characteristics and SOA.Results: A total of 217 children were included. Sixty-one (28%) children had SOA; 33 of 61 (54%) had incision and drainage within 4 hours of the US. Of children with SOA, 49 (80%) grew MRSA and 12 (20%) grew methicillin-sensitive S. aureus. In univariate analysis, a history of MRSA, symptom duration 4 days or less, age of younger than 4 years, and Hispanic ethnicity increased the odds of having SOA. In multivariate analysis, history of MRSA and duration of 4 days or less were associated with SOA.Conclusions: Twenty-eight percent of children in our institution with US of the buttock and perineum negative for abscess had clinical abscess within 48 hours, most within 4 hours. History of MRSA and shorter symptom duration increased the odds of SOA.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Sonographically Occult Abscesses of the Buttock and Perineum in Children

Nelson

Kaplan²,

Bellah³

et al. 2017

Pediatr Emer Care

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“…In children, fever has been observed to double the risk of initial treatment failure. 79 In the study by Berger et al, initial treatment failure (defined as a new antibiotic being given more than 24 h after hospital admission, drainage or debridement, or amputation more than 72 h after hospital admission) occurred in 16.6% of acute infections (cellulitis or abscess) and in 26.7% of SSIs. 64 Treatment failure resulted in a longer hospital stay (an additional 4.1-7.3 days) and a higher probability of mortality.…”

Section: Unfavorable Outcomes With Inappropriate Absssi Managementmentioning

confidence: 99%

Management of acute bacterial skin and skin structure infections with a focus on patients at high risk of treatment failure

Pulido-Cejudo

Guzmán-Gutiérrez

Jalife-Montaño

et al. 2017

Therapeutic Advances in Infection

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Over the last 25 years, the terminology of skin and soft tissue infections, as well as their classification for optimal management of patients, has changed. The so-called and recently introduced term 'acute bacterial skin and skin structure infections' (ABSSSIs), a cluster of fairly common types of infection, including abscesses, cellulitis, and wound infections, require an immediate effective antibacterial treatment as part of a timely and cautious management. The extreme level of resistance globally to many antibiotic drugs in the prevalent causative pathogens, the presence of risk factors of treatment failure, and the high epidemic of comorbidities (e.g. diabetes and obesity) make the appropriate selection of the antibiotic for physicians highly challenging. The selection of antibiotics is primarily empirical for ABSSSI patients which subsequently can be adjusted based on culture results, although rarely available in outpatient management. There is substantial evidence suggesting that inappropriate antibiotic treatment is given to approximately 20-25% of patients, potentially prolonging their hospital stay and increasing the risk of morbidity and mortality. The current review paper discusses the concerns related to the management of ABSSSI and the patient types who are most vulnerable to poor outcomes. It also highlights the key management time-points that treating physicians and surgeons must be aware of in order to achieve clinical success and to discharge patients from the hospital as early as possible.

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Pelvic inflammatory disease in adolescents

Yusuf¹,

Trent²

2023

Encyclopedia of Child and Adolescent Health

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Failure of Emergency Department Observation Unit Treatment for Skin and Soft Tissue Infections

Cited by 7 publications

References 31 publications

Sonographically Occult Abscesses of the Buttock and Perineum in Children

Sonographically Occult Abscesses of the Buttock and Perineum in Children

Management of acute bacterial skin and skin structure infections with a focus on patients at high risk of treatment failure

Pelvic inflammatory disease in adolescents

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