title: A Randomized Clinical Trial Comparing Use of Rapid Molecular Testing for Staphylococcus aureus for Patients With Cutaneous Abscesses in the Emergency Department With Standard of Care.
abstract: OBJECTIVE
  To determine whether real-time availability of rapid molecular results of Staphylococcus aureus would impact emergency department clinician antimicrobial selection for adults with cutaneous abscesses.
  
  
  METHODS
  We performed a prospective, randomized controlled trial comparing a rapid molecular test with standard of care culture-based testing. Follow-up telephone calls were made at between 2 and 7 days, 1 month, and 3 months after discharge.
  
  
  METHODS
  Two urban, academic emergency departments.
  
  
  METHODS
  Patients at least 18 years old presenting with a chief complaint of abscess, cellulitis, or insect bite and receiving incision and drainage were eligible. Seven hundred seventy-eight people were assessed for eligibility and 252 met eligibility criteria.
  
  
  METHODS
  Clinician antibiotic selection and clinical outcomes were evaluated. An ad hoc outcome of test performance was performed.
  
  
  RESULTS
  We enrolled 252 patients and 126 were randomized to receive the rapid test. Methicillin-susceptible S. aureus-positive patients receiving rapid test results were prescribed beta-lactams more often than controls (absolute difference, 14.5% [95% CI, 1.1%-30.1%]) whereas methicillin-resistant S. aureus-positive patients receiving rapid test results were more often prescribed anti-methicillin-resistant S. aureus antibiotics (absolute difference, 21.5% [95% CI, 10.1%-33.0%]). There were no significant differences between the 2 groups in 1-week or 3-month clinical outcomes.
  
  
  CONCLUSIONS
  Availability of rapid molecular test results after incision and drainage was associated with more-targeted antibiotic selection. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01523899.
authors: 1Emergency Department Antibiotic Stewardship,Department of Emergency Medicine,University of California-Davis,Sacramento,California.
authors: Larissa S
authors: LS
authors: May
authors: 2Department of Emergency Medicine,Johns Hopkins University,Baltimore,Maryland.
authors: Richard E
authors: RE
authors: Rothman
authors: 3Los Angeles BioMedical Research Center at Harbor-UCLA Medical Center,Torrance,California.
authors: Loren G
authors: LG
authors: Miller
authors: 4Department of Emergency Medicine,George Washington University,Washington,DC.
authors: Gillian
authors: G
authors: Brooks
authors: 5Office for Clinical Practice Innovation,George Washington University,Washington,DC.
authors: Mark
authors: M
authors: Zocchi
authors: 4Department of Emergency Medicine,George Washington University,Washington,DC.
authors: Catherine
authors: C
authors: Zatorski
authors: 3Los Angeles BioMedical Research Center at Harbor-UCLA Medical Center,Torrance,California.
authors: Andrea F
authors: AF
authors: Dugas
authors: 4Department of Emergency Medicine,George Washington University,Washington,DC.
authors: Chelsea E
authors: CE
authors: Ware
authors: 6Department of Epidemiology and Biostatistics,School of Public Health,George Washington University,Washington,DC.
authors: Jeanne A
authors: JA
authors: Jordan
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015142:Baltimore; D004219:District of Columbia; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D011446:Prospective Studies; D059039:Standard of Care; D013207:Staphylococcal Skin Infections / Q000175:diagnosis / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D016896:Treatment Outcome; D019037:Urban Health Services; D047090:beta-Lactams / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams