title: Treatment Failure Outcomes for Emergency Department Patients with Skin and Soft Tissue Infections.
abstract: BACKGROUND
  Skin and soft tissue infections (SSTIs) are commonly evaluated in the emergency department (ED). Our objectives were to identify predictors of SSTI treatment failure within one week post-discharge in patients with cutaneous abscesses, as well as to identify predictors of recurrence within three months in that proportion of participants.
  
  
  METHODS
  This was a sub-analysis of a parent study, conducted at two EDs, evaluating a new, nucleic acid amplification test (NAAT) for Staphylococcus aureus in ED patients. Patients≥18 years receiving incision and drainage (I&D) were eligible. Patient-reported outcome data on improvement of fever, swelling, erythema, drainage, and pain were collected using a structured abstraction form at one week, one month, and three months post ED visit.
  
  
  RESULTS
  We enrolled 272 participants (20 from a feasibility study and 252 in this trial), of which 198 (72.8%) completed one-week follow up. Twenty-seven additional one-week outcomes were obtained through medical record review rather than by the one-week follow-up phone call. One hundred ninety-three (73%) patients completed either the one- or three-month follow up. Most patients recovered from their initial infection within one week, with 10.2% of patients reporting one-week treatment failure. The odds of treatment failure were 66% lower for patients who received antibiotics following I&D at their initial visit. Overall SSTI recurrence rate was 28.0% (95% CI [21.6%-34.4%]) and associated with contact with someone infected with methicillin resistant S. aureus (MRSA), previous SSTI history, or clinician use of wound packing.
  
  
  CONCLUSIONS
  Treatment failure was reduced by antibiotic use, whereas SSTI recurrence was associated with prior contact, SSTI, or use of packing.
authors.affiliation: University of California, Davis, Department of Emergency Medicine, Davis, California.
authors.forename: Larissa S
authors.initials: LS
authors.lastname: May
authors.affiliation: The George Washington University, Office for Clinical Practice Innovation, Washington, District of Columbia.
authors.forename: Mark
authors.initials: M
authors.lastname: Zocchi
authors.affiliation: The George Washington University, Department of Emergency Medicine, Washington, District of Columbia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Zatorski
authors.affiliation: The George Washington University, Department of Epidemiology and Biostatistics, Washington, District of Columbia.
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Jordan
authors.affiliation: Johns Hopkins University, Department of Emergency Medicine, Baltimore, Maryland.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rothman
authors.affiliation: The George Washington University, Department of Emergency Medicine, Washington, District of Columbia.
authors.forename: Chelsea E
authors.initials: CE
authors.lastname: Ware
authors.affiliation: Los Angeles BioMedical Research Center at Harbor - UCLA Medical Center, Torrance, California.
authors.forename: Samantha
authors.initials: S
authors.lastname: Eells
authors.affiliation: Los Angeles BioMedical Research Center at Harbor - UCLA Medical Center, Torrance, California.
authors.forename: Loren
authors.initials: L
authors.lastname: Miller
mesh_terms: D000038:Abscess / Q000628:therapy; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D012307:Risk Factors; D012874:Skin Diseases, Infectious / Q000188:drug therapy / Q000628:therapy*; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000628:therapy*; D013207:Staphylococcal Skin Infections / Q000188:drug therapy / Q000628:therapy; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents