title: All purulence is local - epidemiology and management of skin and soft tissue infections in three urban emergency departments.
abstract: BACKGROUND
  Skin and soft tissue infection (SSTIs) are commonly treated in emergency departments (EDs). While the precise role of antibiotics in treating SSTIs remains unclear, most SSTI patients receive empiric antibiotics, often targeted toward methicillin-resistant Staphylococcus aureus (MRSA). The goal of this study was to assess the efficiency with which ED clinicians targeted empiric therapy against MRSA, and to identify factors that may allow ED clinicians to safely target antibiotic use.
  
  
  METHODS
  We performed a retrospective analysis of patient visits for community-acquired SSTIs to three urban, academic EDs in one northeastern US city during the first quarter of 2010. We examined microbiologic patterns among cultured SSTIs, and relationships between clinical and demographic factors and management of SSTIs.
  
  
  RESULTS
  Antibiotics were prescribed to 86.1% of all patients. Though S. aureus (60% MRSA) was the most common pathogen cultured, antibiotic susceptibility differed between adult and pediatric patients. Susceptibility of S. aureus from ED SSTIs differed from published local antibiograms, with greater trimethoprim resistance and less fluoroquinolone resistance than seen in S. aureus from all hospital sources. Empiric antibiotics covered the resultant pathogen in 85.3% of cases, though coverage was frequently broader than necessary.
  
  
  CONCLUSIONS
  Though S. aureus remained the predominant pathogen in community-acquired SSTIs, ED clinicians did not accurately target therapy toward the causative pathogen. Incomplete local epidemiologic data may contribute to this degree of discordance. Future efforts should seek to identify when antibiotic use can be narrowed or withheld. Local, disease-specific antibiotic resistance patterns should be publicized with the goal of improving antibiotic stewardship.
authors.affiliation: Department of Emergency Medicine, Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA. cmerritt@brown.edu.
authors.forename: Chris
authors.initials: C
authors.lastname: Merritt
authors.forename: John P
authors.initials: JP
authors.lastname: Haran
authors.forename: Jacob
authors.initials: J
authors.lastname: Mintzer
authors.forename: Joseph
authors.initials: J
authors.lastname: Stricker
authors.forename: Roland C
authors.initials: RC
authors.lastname: Merchant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004636:Emergency Service, Hospital; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009511:New England / Q000453:epidemiology; D011787:Quality of Health Care; D012189:Retrospective Studies; D012874:Skin Diseases, Infectious / Q000188:drug therapy / Q000453:epidemiology; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents