Elderly patients are at increased risk for treatment failure in outpatient management of purulent skin infections.
OBJECTIVE
Current Infectious Disease Society of America (IDSA) guidelines for the management of purulent skin or soft tissue infections do not account for patient age in treatment recommendations. The study objective was to determine if age was associated with outpatient treatment failure for purulent skin infection after adjusting for IDSA treatment guidelines.


METHODS
We conducted a multicenter retrospective study of adult patients treated for a purulent skin infection and discharged home from four emergency departments between April and September 2014. Patients were followed for one month to assess for treatment failure (defined as need for a change in antibiotics, surgical intervention, or hospitalization). We used multivariable logistic regression to examine the role of patient age on treatment failure adjusting for demographic variables (gender, race), comorbidities and severity of infection.


RESULTS
A total of 467 patients met inclusion criteria (mean age 37.9years [SD 14.0], 48.2% of whom were women). Overall, 12.4% failed initial therapy. Patients 65years and older (n=35) were almost 4 times more likely to fail initial ED therapy in follow-up compared with younger patients (adjusted Odds Ratio (OR) 3.87, 95% Confidence Interval (CI) 1.24-12.10). After adjustment, for every 10years of advancing age there was a 43% increased odds of failing initial treatment (OR 1.43 95% CI 1.09-1.88).


CONCLUSIONS
Elderly patients with purulent skin infections, whose providers followed the 2014 IDSA guidelines, were more likely to fail initial treatment than younger patients. This study suggests that there is a need to re-evaluate treatment guidelines in elderly patients.
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States. Electronic address: john.haran@umassmed.edu.
John P
JP
Haran
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
Eric
E
Wilsterman
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
Tyler
T
Zeoli
Department of Emergency Medicine, Alpert School of Medicine, Brown University, Providence, RI, United States.
Francesca L
FL
Beaudoin
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
Jennifer
J
Tjia
Department of Pediatrics and Division of Global Health, Massachusetts General Hospital, Boston, MA, United States.
Patricia L
PL
Hibberd
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D010045:Outpatients / Q000706:statistics & numerical data*; D019152:Paracentesis / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012874:Skin Diseases, Infectious / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D017211:Treatment Failure
D000900:Anti-Bacterial Agents