scholarly journals Antimicrobial treatment decision for non-purulent skin and soft tissue infections in the emergency department

CJEM ◽  
2016 ◽  
Vol 19 (3) ◽  
pp. 175-180 ◽  
Author(s):  
Krishan Yadav ◽  
Mathieu Gatien ◽  
Vicente Corrales-Medina ◽  
Ian Stiell
Keyword(s):  
Risk Factors ◽  
Soft Tissue ◽  
Treatment Failure ◽  
Perceived Risk ◽  
Antimicrobial Treatment ◽  
Soft Tissue Infections ◽  
Oral Antibiotics ◽  
Emergency Physicians ◽  
Canadian Association ◽  
Patient Reported

AbstractObjectivesWe surveyed Canadian emergency physicians to determine how skin and soft tissue infections (SSTIs) are managed and which risk factors were felt to be important in predicting failure with oral antibiotics.MethodsWe performed an electronic survey of physician members of the Canadian Association of Emergency Physicians (CAEP) using the modified Dillman method.ResultsThe survey response rate was 36.9% (n=391) amongst CAEP members. There was a lack of consensus regarding management of SSTIs. CAEP respondents identified 14 risk factors for predicting treatment failure with oral antibiotics, including hypotension, tachypnea, and patient reported severity of pain >8 of 10.ConclusionsThe survey demonstrates significant variability regarding physician management of SSTIs, and we have identified several perceived risk factors for treatment failure with oral antibiotics that should be assessed in future studies.

scholarly journals 451. High Rates of Hospitalization due to Skin and Soft-Tissue Infections in a Southwest American Indian Population

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S221-S222
Author(s):  
Anne M Davidson ◽  
Terry Burgess ◽  
Agafe Saguros ◽  
Chu Jian Ma ◽  
James McAuley ◽  
...  
Keyword(s):  
Risk Factors ◽  
Soft Tissue ◽  
American Indians ◽  
Subcutaneous Tissue ◽  
American Southwest ◽  
Soft Tissue Infections ◽  
Pathogenic Organism ◽  
Critical Access Hospital ◽  
Potential Risk Factors ◽  
Significant Health

Abstract Background Skin and soft-tissue infections (SSTIs) involve the skin, subcutaneous tissue, fascia, or muscle. Hospitalizations due to SSTIs represent a significant health disparity for American Indians (AI), but specific literature is limited. We characterized SSTI hospitalizations at our critical access hospital that exclusively serves an AI population in the American Southwest. Methods We identified patients hospitalized (admitted or transferred) with an SSTI from June 2017 to May 2018. Relevant cases underwent chart extraction for demographics, SSTI characteristics, laboratory and microbiologic data, relevant history and co-morbidities. All variables were summarized using descriptive statistics. Odds ratios and P-values with two-tailed tests were used to identify risk factors for multiple SSTI episodes. Results During the study period, 289 unique individuals comprised 343 SSTI hospitalizations / episodes (18% of the 1,883 total hospitalizations). The unadjusted annual rate of SSTI hospitalization was 2,018 per 100,000. There were 13 cases of necrotizing fasciitis (NF) with an unadjusted rate of 76 per 100,000 per year. Only 183 episodes (53%) had a wound culture performed, with 84% positive for a pathogenic organism, compared with 287 episodes (84%) with a blood culture performed, of which only 7% were positive for a pathogen. Methicillin-resistant Staphylococcus aureus (MRSA), methicillin-sensitive SA (MSSA)and/or Streptococcus pyogenes accounted for 74.9% (n = 125) and co-infection with these three organisms accounted for 22.2% (n = 37) of positive wound cultures (n = 167). An SSTI in the last year (49%), diabetes (41.9%), alcohol abuse (40%) and hypertension (39%) were common among all 289 individuals. Diabetes (OR 3.3, P < 0.01), hypertension (OR 2.8, P < 0.01), renal disease (OR 2.7, P < 0.05), previous SSTI (OR 3.0, P < 0.01) were associated with a higher risk of multiple SSTI hospitalizations. Conclusion The incidence rate of SSTI hospitalization in this Southwest AI population was 9-times greater than the general US population and 4-times greater than prior reports in Southwest AI. The NF rate was >10-times the general US population rate. We describe common co-morbidities among these SSTI episodes and potential risk factors for repeat hospitalization. Disclosures All authors: No reported disclosures.

scholarly journals P103: How knowledgeable are Canadian emergency physicians about the risk factors of completing suicide in patients presenting to the ED with suicidal thoughts?

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S102-S102
Author(s):  
J. Fernandes ◽  
A. Chakraborty ◽  
F. Scheuermeyer ◽  
S. Barbic ◽  
D. Barbic
Keyword(s):  
Risk Factors ◽  
Low Socioeconomic Status ◽  
Emergency Physicians ◽  
Suicidal Thoughts ◽  
Web Based ◽  
Personal Lives ◽  
Low Socioeconomic ◽  
Canadian Association ◽  
Attending Physician ◽  
Risk Factors For Suicide

Introduction: Suicide is the 9th leading cause of death in Canada, and a common reason for patients to present to Canadian emergency departments (ED). Little knowledge exists around Canadian emergency physicians (EPs) knowledge about the risk factors of completing suicide in patients presenting to the ED with suicidal thoughts. Methods: We developed a web-based survey on suicide knowledge, which was pilot tested by two emergency physicians and one psychiatrist for clarity and content. The survey was distributed via email to attending physician members of the Canadian Association of Emergency Physicians. Data were described using counts, means, medians and interquartile ranges. Results: 193 EPs responded to the survey (response rate 16%), with 42% of EPs practicing in Ontario. 35% of EPs were female, the mean age was 48 (95% CI 47.3-48.7), and mean years in practice was 17 (95% CI 16.3-17.7). Academic practice location was reported by 55% of EPs, and 81% reported access to an inpatient psychiatry service. Twenty four (12%) EPs had personally considered suicide, and 45% had experience with suicide in their personal lives. The top three risk factors for suicide identified by EPs were: intent for suicide (90%); a plan for suicide (89%); prior suicide attempt (88%). A majority of EPs were able to correctly identify the other risk factors for completion of suicide except for the following: diagnosis of anxiety disorder (25%), chronic substance use (43%), prior non-suicidal self-injury (37%), low socioeconomic status (34%). Conclusion: Canadian EPs have substantial personal experience with suicide. A majority of EPs were able to correctly identify known risk factors for suicide completion, yet important gaps in knowledge exist.

scholarly journals LO52: Predictors of oral antibiotic treatment failure for non-purulent skin and soft tissue infections in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S24-S25 ◽  
Author(s):  
K. Yadav ◽  
K. Suh ◽  
D. Eagles ◽  
J. MacIsaac ◽  
D. Ritchie ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Antibiotic Treatment ◽  
Oral Antibiotic ◽  
Soft Tissue Infections ◽  
Emergency Physicians ◽  
Intravenous Antibiotic ◽  
The Past ◽  
History Of ◽  
Chronic Ulcers ◽  
Mrsa Colonization

Introduction: Current guideline recommendations for optimal management of non-purulent skin and soft tissue infections (SSTIs) are based on expert consensus. There is currently a lack of evidence to guide emergency physicians on when to select oral versus intravenous antibiotic therapy. The primary objective was to identify risk factors associated with oral antibiotic treatment failure. A secondary objective was to describe the epidemiology of adult emergency department (ED) patients with non-purulent SSTIs. Methods: We performed a health records review of adults (age 18 years) with non-purulent SSTIs treated at two tertiary care EDs. Patients were excluded if they had a purulent infection or infected ulcers without surrounding cellulitis. Treatment failure was defined any of the following after a minimum of 48 hours of oral therapy: (i) hospitalization for SSTI; (ii) change in class of oral antibiotic owing to infection progression; or (iii) change to intravenous therapy owing to infection progression. Multivariable logistic regression was used to identify predictors independently associated with the primary outcome of oral antibiotic treatment failure after a minimum of 48 hours of oral therapy. Results: We enrolled 500 patients (mean age 64 years, 279 male (55.8%) and 126 (25.2%) with diabetes) and the hospital admission rate was 29.6%. The majority of patients (70.8%) received at least one intravenous antibiotic dose in the ED. Of 288 patients who had received a minimum of 48 hours of oral antibiotics, there were 85 oral antibiotic treatment failures (29.5%). Tachypnea at triage (odds ratio [OR]=6.31, 95% CI=1.80 to 22.08), chronic ulcers (OR=4.90, 95% CI=1.68 to 14.27), history of MRSA colonization or infection (OR=4.83, 95% CI=1.51 to 15.44), and cellulitis in the past 12 months (OR=2.23, 95% CI=1.01 to 4.96) were independently associated with oral antibiotic treatment failure. Conclusion: This is the first study to evaluate potential predictors of oral antibiotic treatment failure for non-purulent SSTIs in the ED. We observed a high rate of treatment failure and hospitalization. Tachypnea at triage, chronic ulcers, history of MRSA colonization or infection and cellulitis within the past year were independently associated with oral antibiotic treatment failure. Emergency physicians should consider these risk factors when deciding on oral versus intravenous antimicrobial therapy for non-purulent SSTIs being managed as outpatients.

Treatment failure definitions for non-purulent skin and soft tissue infections: a systematic review

Infection ◽  
2019 ◽  
Vol 48 (1) ◽  
pp. 75-83
Author(s):  
Krishan Yadav ◽  
Avik Nath ◽  
Kathryn N. Suh ◽  
Lindsey Sikora ◽  
Debra Eagles
Keyword(s):  
Systematic Review ◽  
Soft Tissue ◽  
Treatment Failure ◽  
Soft Tissue Infections

scholarly journals High Staphylococcus aureus Colonization Prevalence among Patients with Skin and Soft Tissue Infections and Controls in an Urban Emergency Department

2014 ◽  
Vol 53 (3) ◽  
pp. 810-815 ◽  
Author(s):  
Neha Kumar ◽  
Michael Z. David ◽  
Susan Boyle-Vavra ◽  
Julia Sieth ◽  
Robert S. Daum
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
The United States ◽  
Antimicrobial Treatment ◽  
Soft Tissue Infections ◽  
Content Type ◽  
Treatment Regimens ◽  
Commensal Species ◽  
High Prevalence

Staphylococcus aureusis a commensal species that can also be a formidable pathogen. In the United States, an epidemic of community-acquired methicillin-resistantStaphylococcus aureus(MRSA) infections has been occurring for the last 15 years. In the context of a study in which we identified patients with skin and soft tissue infections (SSTIs) and randomized them to receive one of two antimicrobial treatment regimens, we assessedS. aureuscolonization in the nares, throat, and perianal skin on the day of enrollment and 40 days after therapy. We compared the prevalence of colonization between the SSTI patients and an uninfected control population. A total of 144 subjects and 130 controls, predominantly African American, participated in this study, and 116 returned for a 40-day follow-up visit. Of the SSTI patients, 76% were colonized withS. aureusat enrollment, as were 65% of the controls. Patients were more likely than the controls to be colonized with USA300 MRSA (62/144 [43.1%] versus 11/130 [8.5%], respectively;P< 0.001). The nares were not the most common site of colonization. The colonization prevalence diminished somewhat after antibiotic treatment but remained high. The isolates that colonized the controls were more likely than those in the patients to be methicillin-susceptibleS. aureus(MSSA) (74/84 [88.1%] versus 56/106 [52.8%], respectively;P< 0.001). In conclusion, the prevalence ofS. aureuscolonization among SSTI patients was high and often involved USA300 MRSA. The prevalence diminished somewhat with antimicrobial therapy but remained high at the 40-day follow-up visit. Control subjects were also colonized at a high prevalence but most often with a genetic background not associated with a clinical infection in this study.S. aureusis a commensal species and a pathogen. Plans for decolonization or eradication should take this distinction into account.

scholarly journals Relationship between Adherence to Oral Antibiotics and Postdischarge Clinical Outcomes among Patients Hospitalized with Staphylococcus aureus Skin Infections

2016 ◽  
Vol 60 (5) ◽  
pp. 2941-2948 ◽  
Author(s):  
Samantha J. Eells ◽  
Megan Nguyen ◽  
Jina Jung ◽  
Raul Macias-Gil ◽  
Larissa May ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Antibiotic Therapy ◽  
Clinical Response ◽  
Clinical Outcomes ◽  
Hospital Discharge ◽  
Oral Antibiotic ◽  
Soft Tissue Infections ◽  
Oral Antibiotics ◽  
Oral Antibiotic Therapy

ABSTRACTSkin and soft tissue infections are common and frequently recur. Poor adherence to antibiotic therapy may lead to suboptimal clinical outcomes. However, adherence to oral antibiotic therapy for skin and soft tissue infections and its relationship to clinical outcomes have not been examined. We enrolled adult patients hospitalized with uncomplicated skin and soft tissue infections caused byStaphylococcus aureuswho were being discharged with oral antibiotics to complete therapy. We fit the participants' pill bottles with an electronic bottle cap that recorded each pill bottle opening, administered an in-person standardized questionnaire at enrollment, 14 days, and 30 days, and reviewed the participants' medical records to determine outcomes. Our primary outcome was poor clinical response, defined as a change in antibiotic therapy, new incision-and-drainage procedure, or new skin infection within 30 days of hospital discharge. Of our 188 participants, 87 had complete data available for analysis. Among these participants, 40 (46%) had a poor clinical response at 30 days. The mean electronically measured adherence to antibiotic therapy was significantly different than the self-reported adherence (57% versus 96%;P< 0.0001). In a multivariable model, poor clinical response at 30 days was associated with patients having lower adherence, being nondiabetic, and reporting a lack of illicit drug use within the previous 12 months (P< 0.05). In conclusion, we found that patient adherence to oral antibiotic therapy for a skin and soft tissue infection after hospital discharge was low (57%) and associated with poor clinical outcome. Patients commonly overstate their medication adherence, which may make identification of patients at risk for nonadherence and poor outcomes challenging. Further studies are needed to improve postdischarge antibiotic adherence after skin and soft tissue infections.

scholarly journals Staphylococcus aureus Colonisation in HIV-Infected Patients: Incidence, Risk Factors and Subsequent Skin- and Soft-Tissue Infections

2020 ◽  
Vol 38 (3-4) ◽  
pp. 444-447
Author(s):  
Aashirwad Panigrahy ◽  
Sanjeev Sinha ◽  
Bimal Kumar Das ◽  
Arti Kapil ◽  
Sreenivas Vishnubhatla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Soft Tissue Infections ◽  
Incidence Risk

scholarly journals Risk Factors and Predictors of Mortality in Streptococcal Necrotizing Soft-tissue Infections: A Multicenter Prospective Study

2020 ◽  
Author(s):  
Trond Bruun ◽  
Eivind Rath ◽  
Martin Bruun Madsen ◽  
Oddvar Oppegaard ◽  
Michael Nekludov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Soft Tissue ◽  
Blunt Trauma ◽  
Gene Profiling ◽  
Soft Tissue Infections ◽  
Lasso Regression ◽  
Factors Associated ◽  
Necrotizing Soft Tissue Infections ◽  
The Impact

Abstract Background Necrotizing soft-tissue infections (NSTI) are life-threatening conditions often caused by β-hemolytic streptococci, group A Streptococcus (GAS) in particular. Optimal treatment is contentious. The INFECT cohort includes the largest set of prospectively enrolled streptococcal NSTI cases to date. Methods From the INFECT cohort of 409 adults admitted with NSTI to 5 clinical centers in Scandinavia, patients culture-positive for GAS or Streptococcus dysgalactiae (SD) were selected. Risk factors were identified by comparison with a cohort of nonnecrotizing streptococcal cellulitis. The impact of baseline factors and treatment on 90-day mortality was explored using Lasso regression. Whole-genome sequencing of bacterial isolates was used for emm typing and virulence gene profiling. Results The 126 GAS NSTI cases and 27 cases caused by SD constituted 31% and 7% of the whole NSTI cohort, respectively. When comparing to nonnecrotizing streptococcal cellulitis, streptococcal NSTI was associated to blunt trauma, absence of preexisting skin lesions, and a lower body mass index. Septic shock was significantly more frequent in GAS (65%) compared to SD (41%) and polymicrobial, nonstreptococcal NSTI (46%). Age, male sex, septic shock, and no administration of intravenous immunoglobulin (IVIG) were among factors associated with 90-day mortality. Predominant emm types were emm1, emm3, and emm28 in GAS and stG62647 in SD. Conclusions Streptococcal NSTI was associated with several risk factors, including blunt trauma. Septic shock was more frequent in NSTI caused by GAS than in cases due to SD. Factors associated with mortality in GAS NSTI included age, septic shock, and no administration of IVIG.

Outpatient intravenous antimicrobial treatment of soft tissue infections

1999 ◽  
Vol 39 (1) ◽  
pp. A22
Author(s):  
S. Pettett ◽  
R.B.S. Laing ◽  
C.C. Smith ◽  
J.G. Douglas
Keyword(s):  
Soft Tissue ◽  
Antimicrobial Treatment ◽  
Soft Tissue Infections
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