Trends in emergency department management of skin abscesses.
BACKGROUND
Abscess is a distinct skin and soft tissue infection (SSTI) requiring incision and drainage (I&D). Previous national surveys combined all SSTIs to estimate abscess and evaluate management. We hypothesized that antibiotic rates are declining in response to evidence that antibiotics are unnecessary for most SSTIs requiring I&D.


METHODS
Emergency department (ED) patients included in the National Hospital Ambulatory Medical Care Survey from 2007-2010 with diagnosis codes for cutaneous abscess or SSTI were filtered using a procedure code for I&D available since 2007. The number of patients with SSTI, the percentage of patients receiving I&D, and the percentage of patients receiving antibiotics were determined. Antibiotics were characterized based on efficacy to methicillin-resistant Staphylococcus aureus (MRSA).


RESULTS
ED visits for SSTI increased from 3.55 million (95% confidence interval [CI], 3.24 million-3.86 million) in 2007 to 4.21 million (95% CI, 3.89 million-4.55 million) in 2010. Incidences of I&D rose from 736,000 (95% CI, 602,000-869,000) to 1.48 million (95% CI, 1.30 million-1.65 million) and comprised 32.2% of SSTI visits over the 4 years. In 2007, 85.1% (95% CI, 82.6%-87.7%) of patients received antibiotics after I&D with no change over 4 years. In 2010, 15.5% (95% CI, 12.1%-18.7%) received ≥2 antibiotics. Commonly prescribed antibiotics were trimethoprim-sulfamethoxazole (mean, 50.4%) followed by cephalexin (mean, 17.2%) and clindamycin (mean, 16.3%).


CONCLUSIONS
ED visits for SSTIs continue to rise. Despite mounting evidence, antibiotic use in SSTIs requiring I&D is high, and many patients receive multiple antibiotics, including drugs with no efficacy on MRSA.
Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA. Electronic address: mkprusakowski@carilionclinic.org.
Melanie K
MK
Prusakowski
Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA.
Damon R
DR
Kuehl
D000038:Abscess / Q000175:diagnosis / Q000188:drug therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D059019:Clinical Coding; D016208:Databases, Factual; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000592:standards* / Q000639:trends*; D019538:Health Care Surveys; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D012874:Skin Diseases, Infectious / Q000175:diagnosis / Q000188:drug therapy*; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D002981:Clindamycin
Abscess; Incision and drainage; Methicillin-resistant Staphylococcus aureus; Skin and soft tissue infection