scholarly journals Antibiotic Duration, but Not Abscess Size, Impacts Clinical Cure of Limited Skin and Soft Tissue Infection After Incision and Drainage

2019 ◽  
Vol 71 (3) ◽  
pp. 661-663
Author(s):  
Jason G Lake ◽  
Loren G Miller ◽  
Stephanie A Fritz
Keyword(s):  
Clinical Trial ◽  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Clinical Cure ◽  
Incision And Drainage ◽  
Antibiotic Effect ◽  
Subgroup Analyses ◽  
Recent Clinical Trial ◽  
Antibiotic Duration ◽  
Antibiotic Courses

Abstract Antibiotics are frequently prescribed following incision and drainage of cutaneous abscesses. In subgroup analyses from a recent clinical trial, we observed higher likelihood of cure with antibiotic courses beyond 5 or 7 days (up to 10). Among this cohort, for abscesses ≤5 cm, size did not modify the antibiotic effect.

scholarly journals 452. Antibiotic Duration, but Not Size, Impacts Clinical Cure of Limited Skin and Soft-Tissue Infection After Incision and Drainage

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S222-S223
Author(s):  
Jason G Lake ◽  
Stephanie Fritz
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Clinical Cure ◽  
Day Treatment ◽  
Treatment Protocol ◽  
Chi Square ◽  
Incision And Drainage ◽  
Exact Test ◽  
Days Of Therapy ◽  
Antibiotic Duration

Abstract Background Incision and drainage (I&D) is the most common treatment for skin abscesses. A recent randomized clinical trial (RCT) of outpatients with limited (≤5 cm) skin abscesses demonstrated antibiotic therapy with clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX) was superior to I&D alone. We performed a subgroup analysis to measure the effect of antibiotic duration and abscess size on clinical cure at 7–10 days after antibiotic completion. Methods Participants with complete data regarding adherence to the 10-day treatment were included. Demographic and baseline clinical features were compared using t-test, Pearson’s chi-square or Fisher’s exact test, or a non-parametric equivalent where appropriate. Largest abscess dimension (cm) was dichotomized by median size. The effect of antibiotic duration, abscess size (≤ median vs. >median) and covariates on clinical cure were measured using logistic regression. Breslow-Day Test for Homogeneity was used to assess the interaction between treatment and abscess size. Results Of 786 participants in the intention-to-treat analysis, complete adherence data were available for 680 (87%) participants. Of these, 463 (68%) received either antibiotic: 421 (91%) completed 10 days of therapy, 29 (6.3%) ≤7 days and 20 (4.3%) ≤5 days. Only antibiotic treatment duration was associated with clinical cure (table). Odds of clinical cure were 1.7 (95% CI: 1.5, 2.0) times higher for each additional day of treatment. Median abscess size was 2.5 cm (range: 0.2–5); 364 participants had abscesses ≤ median vs. 316 >median. Assessed continuously, abscess size was not associated with cure within antibiotic groups (table) or between placebo and treatment groups (OR 0.94, 95% CI: 0.58–1.5). Stratifying on size, no significant interaction was observed with antibiotic treatment (Breslow-Day P = 0.13). Conclusion Adherence to the treatment protocol was high. These data suggest that longer courses of antibiotic therapy in conjunction with I&D are associated with successful treatment of limited skin abscesses. Size was not associated with clinical cure. Prospective RCTs to determine the optimal length of treatment are needed. Disclosures All authors: No reported disclosures.

scholarly journals Randomized, Double-Blind, Placebo-Controlled Trial of Cephalexin for Treatment of Uncomplicated Skin Abscesses in a Population at Risk for Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection

2007 ◽  
Vol 51 (11) ◽  
pp. 4044-4048 ◽  
Author(s):  
Priya M. Rajendran ◽  
David Young ◽  
Toby Maurer ◽  
Henry Chambers ◽  
Francoise Perdreau-Remington ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Confidence Interval ◽  
Clinical Cure ◽  
Controlled Trial ◽  
Beta Lactam ◽  
Cure Rate ◽  
Double Blind ◽  
Incision And Drainage ◽  
Methicillin Resistant

ABSTRACT Empirical use of beta-lactam antibiotics, the preferred agents for treating uncomplicated skin and soft tissue infections, may no longer be appropriate for these infections because of the increasing prevalence of community strains of methicillin-resistant Staphylococcus aureus (MRSA). Retrospective studies, however, suggest that outcomes are good even when beta-lactams are used. We conducted a randomized, double-blind trial of 166 outpatient subjects comparing placebo to cephalexin at 500 mg orally four times for 7 days after incision and drainage of skin and soft tissue abscesses. The primary outcome was clinical cure or failure 7 days after incision and drainage. S. aureus was isolated from 70.4% of abscess cultures. Of the isolates tested 87.8% were MRSA, 93% of which were positive for Panton-Valentine leucocidin genes. Clinical cure rates were 90.5% (95% confidence interval, 0.82 to 0.96) in the 84 placebo recipients and 84.1% (95% confidence interval, 0.74 to 0.91) in the 82 cephalexin recipients (difference in the two proportions, 0.0006; 95% confidence interval, −0.0461 to 0.0472; P = 0.25). The 90.5% cure rate observed in the placebo arm and 84.1% cure rate observed in the cephalexin arm provide strong evidence that antibiotics may be unnecessary after surgical drainage of uncomplicated skin and soft tissue abscesses caused by community strains of MRSA.

Soft Tissue Infection Associated with Haemophilus aphrophilus

PEDIATRICS ◽  
1981 ◽  
Vol 67 (3) ◽  
pp. 434-435
Author(s):  
Christopher B. White ◽  
Richard M. Lampe ◽  
Randolph L. Copeland ◽  
Robert E. Morrison
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Human Infection ◽  
Tissue Infection ◽  
Abdominal Wound ◽  
Wound Infections ◽  
Incision And Drainage ◽  
Haemophilus Aphrophilus ◽  
The Right

Haemophilus aphrophilus is an uncommon cause of human infection. Brain abscess, 1-5 endocarditis, 2,5-8 abdominal wound infections, 5-9 and infections associated with the oropharynx2,5 are the most commonly reported presentations in children (Table). The presentation and management of a child who developed a soft tissue infection of the leg associated with H aphrophilus are presented. CASE REPORT A 12-year-old boy struck an opponent's mouth with his right knee while playing soccer. No obvious wound was noted. Four days later, the soft tissue about his knee became red, swollen, and tender. The bursa and joint were not involved. Incision and drainage of the subcutaneous abscess near the right knee was accomplished.

Group G Streptococcal Necrotizing Soft Tissue Infection

2016 ◽  
Vol 78 (6) ◽  
pp. 644-649
Author(s):  
Eriko MAEHARA ◽  
Gaku TSUJI ◽  
Yukihiro MIZOTE ◽  
Naohide TAKEUCHI ◽  
Masutaka FURUE
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Tissue Infection ◽  
Necrotizing Soft Tissue Infection

Case Report: When all claims that it is necrotizing fasciitis but Point of care ultrasound (POCUS) proves the opposite!

POCUS Journal ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 13-14
Author(s):  
Hadiel Kaiyasah, MD, MRCS (Glasgow), ABHS-GS ◽  
Maryam Al Ali, MBBS
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Case Report ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Soft Tissue Infection ◽  
Critical Care Unit ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Soft Tissue Infections

Soft tissue ultrasound (ST-USS) has been shown to be of utmost importance in assessing patients with soft tissue infections in the emergency department or critical care unit. It aids in guiding the management of soft tissue infection based on the sonographic findings.

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