title: A Prescription for Resistance: Management of Staphylococcal Skin Abscesses by General Practitioners in Australia.
abstract: OBJECTIVE
  We investigated the management of staphylococcal abscesses (boils) by general practitioners (GPs) in the context of rising antibiotic resistance in community strains of Staphylococcus aureus.
  
  
  METHODS
  We analyzed patient-reported management of 66 cases of uncomplicated skin abscesses from the frequency matched methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) Community-Onset Staphylococcus aureus Household Cohort (COSAHC) study (Melbourne, Australia, 2008-2012). Susceptibilities in all cases were known: 50/66 abscesses were caused by MRSA. In order to investigate GP-reported management of staphylococcal abscesses, we surveyed a random subset of GPs, from the COSAHC study (41), and of GPs (39) who used the same community-based pathology service (December 2011-May 2012).
  
  
  METHODS
  Patient outcomes, antibiotics prescribed, antibiotic resistance profiles of infecting strains, rates of incision and drainage (I&D), and attitudes to ordering microbiological cultures.
  
  
  RESULTS
  MRSA was three times more likely to be cultured from an abscess than MSSA. Patient-reported management revealed 100% were prescribed antibiotics and only 60.6% had I&D. Of those 85% who remembered their prescription(s), 81% of MRSA cases and 23% of MSSA cases initially received inactive antibiotics. Repeat GP visits where antibiotics were changed occurred in 45 MRSA and 7 MSSA cases, although at least 33% of subsequent prescriptions were inactive for the MRSA infections. Patients treated with I&D and antibiotics did no better than those treated with only I&D, regardless of the antibiotic activity. In the GP surveys, 89% reported I&D, with or without antibiotics, to be their preferred management. Only 29.9% of GPs would routinely swab abscesses.
  
  
  CONCLUSIONS
  The recommended management of uncomplicated Staphylococcus abscesses is I&D without antibiotics to reduce exposure to unnecessary antibiotics. In our study, I&D was performed in only 60.6% of 66 patients, and antibiotics were always prescribed. The prescribed antibiotics were frequently inactive and often changed, and did not appear to affect patient recovery. Our results show that community GPs can confidently reduce their use of antibiotics for patients with skin abscesses and should be aware that MRSA is a much more common in this type of infection.
authors.affiliation: Centre for Population Health Research, School of Health and Social Development, Deakin University, GeelongVIC, Australia; Young People's Health Service, Department of Adolescent Medicine, The Royal Children's Hospital, ParkvilleVIC, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Parrott
authors.affiliation: Perinatal Medicine, Mercy Hospital for Women, HeidelbergVIC, Australia; Department of Microbiology, Dorevitch Pathology, HeidelbergVIC, Australia.
authors.forename: Gillian
authors.initials: G
authors.lastname: Wood
authors.affiliation: Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong VIC, Australia.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Bogatyreva
authors.affiliation: School of Veterinary and Life Sciences, Murdoch University, MurdochWA, Australia; PathWest Laboratory Medicine - Fiona Stanley Hospital, MurdochWA, Australia.
authors.forename: Geoffrey W
authors.initials: GW
authors.lastname: Coombs
authors.affiliation: Department of Infectious Diseases, Austin Health, Heidelberg VIC, Australia.
authors.forename: Paul D R
authors.initials: PD
authors.lastname: Johnson
authors.affiliation: Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong VIC, Australia.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Bennett
keywords: Staphylococcus aureus; antibiotic resistance; boils and abscesses; community medicine; skin and soft tissue infections