Introduction

Current guidelines suggest adjuvant antibiotics after incision and drainage (I&D) of small, uncomplicated abscesses may improve patient outcomes, minimize pain, and prevent recurrence. The objective was to explore antibiotic prescribing at ED discharge and describe patient outcomes.

Methods

This was a health records review of adult patients (≥ 18 years) discharged from an academic hospital ED (annual census 65,000) over a 2-year period with diagnosis of an uncomplicated skin abscess. Outcomes included any unplanned return ED visits within 30 days, repeat I&D, and escalation to intravenous (IV) antibiotics.

Results

Of 389 ED visits, 85.6% patients underwent I&D, of which 62.2% were prescribed antibiotics at discharge. Of these patients, 36.7% received guideline recommended antibiotics (TMP-SMX or clindamycin). Of all patients who underwent I&D, 13.2% had an unplanned return ED visit within 30 days, 6.9% required repeat I&D, and 0.6% patients were escalated to IV antibiotics. Patients treated with cefalexin were more likely to have an unplanned return ED visit within 30 days (20.0 vs 5.3%; Δ14.7, 95% CI 4.6–24.4), and were more likely to have a repeat I&D within 30 days (13.7 vs 0%; Δ13.7, 95% CI 6.4–22.0), compared to patients prescribed guideline recommended antibiotics. Treatment with guideline recommended antibiotics reduced treatment failure significantly in MRSA positive patients (0.0 vs 44.4%; Δ44.4, 95% CI 13.4–73.3).

Conclusions

Antibiotics were prescribed for most abscesses that underwent I&D. Less than half of the patients received antibiotics that were guideline recommended. Compared to those who received cefalexin, patients prescribed TMP-SMX or clindamycin had fewer return ED visits and were less likely to have a repeat I&D within 30 days. However, adjuvant antibiotic use did not significantly improve outcomes overall, with most patients not requiring a change in management irrespective of antibiotic use.

中文翻译：

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急诊科单纯化脓性皮肤和软组织感染患者的抗生素处方和结果

介绍

目前的指南建议在小的、无并发症的脓肿切开引流 (I&D) 后使用辅助抗生素可能会改善患者的预后、最大限度地减少疼痛并防止复发。目的是探索 ED 出院时的抗生素处方并描述患者结果。

方法

这是对在 2 年期间从学术医院 ED（每年人口普查 65,000 人）出院并诊断为无并发症的皮肤脓肿的成年患者（≥ 18 岁）的健康记录审查。结果包括 30 天内任何计划外的 ED 复诊、重复 I&D 以及升级至静脉内 (IV) 抗生素。

结果

在 389 次急诊就诊中，85.6% 的患者接受了 I&D，其中 62.2% 在出院时开了抗生素。在这些患者中，36.7% 接受了指南推荐的抗生素（TMP-SMX 或克林霉素）。在接受 I&D 的所有患者中，13.2% 的患者在 30 天内进行了计划外的急诊复诊，6.9% 的患者需要重复 I&D，0.6% 的患者升级为静脉注射抗生素。接受头孢氨苄治疗的患者更有可能在 30 天内进行计划外的急诊复诊（20.0 对 5.3%；Δ14.7，95% CI 4.6–24.4），并且更有可能在 30 天内进行重复 I&D（13.7 对0%；Δ13.7，95% CI 6.4–22.0)，与患者处方指南推荐的抗生素相比。使用指南推荐的抗生素治疗可显着减少 MRSA 阳性患者的治疗失败率（0.0 对 44.4%；Δ44.4，95% CI 13.4–73.3）。

结论

大多数接受 I&D 的脓肿都开具了抗生素。不到一半的患者接受了指南推荐的抗生素治疗。与接受头孢氨苄治疗的患者相比，服用 TMP-SMX 或克林霉素的患者的急诊复诊次数较少，并且在 30 天内重复 I&D 的可能性较小。然而，辅助抗生素的使用并没有显着改善总体结果，无论是否使用抗生素，大多数患者都不需要改变管理。