title: Practice patterns and management strategies for purulent skin and soft-tissue infections in an urban academic ED.
abstract: BACKGROUND
  Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is the most common cause of purulent skin and soft-tissue infections (SSTIs) in the Unites States. Little is known regarding health care provider management strategies for abscesses in the emergency department (ED). Understanding variability in practice patterns could be an important step in implementing evidence-based guidelines.
  
  
  OBJECTIVE
  The objectives of this study are to describe practice patterns for purulent SSTI in a single, urban, academic ED, including antibiotic selection and incision and drainage (I & D) technique, and to compare these practices with current evidence.
  
  
  METHODS
  Prospective data were collected on a convenience sample of adults presenting to our urban, academic ED (annual volume, 65 000 per year) between June 2009 and May 2010. Characteristics of patients and their providers were collected as well as specific management strategies including use of irrigation, packing, and antibiotics.
  
  
  RESULTS
  One hundred forty-five patients were enrolled. Most SSTIs were single (80.4% abscesses), most commonly on the extremities (29.8%). Both I & D and antibiotics were used 79.9% of the time, with the largest predictor for the addition of antibiotics being erythema more than 2 cm (odds ratio, 4.52; 95% confidence interval, 1.39-14.7); I & D technique varied by provider-type and experience. Providers suspected MRSA in 75% of cases, despite only 48% demonstrating MRSA on culture. Many patients received antimicrobials after I & D, even in those with 2 cm or less abscesses (57.5%).
  
  
  CONCLUSIONS
  Practice patterns vary significantly, especially antibiotic overuse, at least in this urban academic ED. Further study should be undertaken to evaluate factors that influence management strategies for SSTI.
authors.affiliation: Department of Emergency Medicine, The George Washington University, Washington, DC, USA. larissa@gwu.edu
authors.forename: Larissa
authors.initials: L
authors.lastname: May
authors.forename: Katherine
authors.initials: K
authors.lastname: Harter
authors.forename: Kabir
authors.initials: K
authors.lastname: Yadav
authors.forename: Ryan
authors.initials: R
authors.lastname: Strauss
authors.forename: Jameel
authors.initials: J
authors.lastname: Abualenain
authors.forename: Amy
authors.initials: A
authors.lastname: Keim
authors.forename: Gillian
authors.initials: G
authors.lastname: Schmitz
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004219:District of Columbia / Q000453:epidemiology; D004322:Drainage / Q000379:methods / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012874:Skin Diseases, Infectious / Q000188:drug therapy / Q000628:therapy*; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents