title: Improving the management of skin and soft tissue infections in primary care: a report from State Networks of Colorado Ambulatory Practices and Partners (SNOCAP-USA) and the Distributed Ambulatory Research in Therapeutics Network (DARTNet).
abstract: BACKGROUND
  Purulent skin and soft tissue infections (SSTIs) requiring medical attention are often managed in primary care. The prevalence of SSTIs caused by community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) has been increasing rapidly, including in otherwise healthy individuals. The Centers for Disease Control and Prevention (CDC) issued guidelines to improve the management of SSTIs in primary care.
  
  
  OBJECTIVE
  In primary care settings, to assess the prevalence of CA-MRSA using an electronic chart audit and then evaluate SSTI management strategies consistent with CDC guidelines.
  
  
  METHODS
  A practical intervention that compared a historical cohort to an intervention cohort of patients seen for SSTI in 16 primary care practices in two health care systems. The intervention included a ready-made kit for I & D procedures, MRSA information for clinicians, a patient information handout, provider education, and patient follow-up.
  
  
  RESULTS
  A total of 3112 SSTI cases (cellulitis or purulent) were observed during the preintervention period and 1406 cases during the intervention. For purulent infections in the intervention period (n = 148), univariate and multivariate analyses showed no significant improvement in the rate of I & D procedures or cultures obtained but showed increased use of antibiotics overall and agents that typically cover MRSA strains (OR, 2.183; 95% CI, 1.443 to 3.303 and 2.624; 95% CI, 1.500 to 4.604, respectively). For infections that were cellulitis with or without purulence (n = 1258), overall rates in the use of antibiotics and those that cover MRSA increased significantly, but secular trends could not be ruled out as an explanation for this increase.
  
  
  CONCLUSIONS
  In SSTIs, this intervention resulted in increased use of antibiotics, including antibiotics that typically cover MRSA strains, but did not demonstrate increased rates of recommended drainage procedures. It is replicable and portable, and may improve antibiotic selection in other settings.
authors: Department of Family Medicine, University of Colorado Denver, Aurora, Colorado, USA. bennett.parnes@ucdenver.edu
authors: Bennett
authors: B
authors: Parnes
authors: Douglas
authors: D
authors: Fernald
authors: Letoynia
authors: L
authors: Coombs
authors: Lauren
authors: L
authors: Dealleaume
authors: Elias
authors: E
authors: Brandt
authors: Brian
authors: B
authors: Webster
authors: L Miriam
authors: LM
authors: Dickinson
authors: Wilson
authors: W
authors: Pace
authors: David
authors: D
authors: West
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration; D019985:Benchmarking; D002481:Cellulitis / Q000382:microbiology; D003120:Colorado; D017714:Community-Acquired Infections; D003625:Data Collection; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012874:Skin Diseases, Infectious / Q000188:drug therapy*; D018461:Soft Tissue Infections / Q000188:drug therapy*