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The role of adjunctive antibiotics in the treatment of skin and soft tissue abscesses: a systematic review and meta-analysis

  • Jahan Fahimi (a1) (a2) (a3), Amandeep Singh (a1) and Bradley W. Frazee (a1)
Abstract
Objective

To perform a review and meta-analysis on the effect of antibiotics on treatment of skin and soft tissue abscesses (SSTAs) after incision and drainage.

Methods

We searched MEDLINE, EMBASE, Web of Knowledge, and Google Scholar databases to identify randomized controlled trials (RCTs) and observational studies. For RCTs, we included studies comparing any antibiotic (treatment) to placebo (control). For observational studies, treatment was the use of appropriate antibiotics effective against bacterial isolate, and control was the use of inappropriate (ineffective) or no antibiotics. Outcome was treatment success during follow-up. Two investigators reviewed records, assessed quality (according to Cochrane and Newcastle-Ottawa tools), and extracted treatment success rates. Primary analysis was the effect of treatment among RCTs. Secondary analyses included the effect of treatment in 1) observational studies of confirmed methicillin-resistant Staphylococcus aureus (MRSA) infection (MRSA-only) and 2) all studies after 1998 (MRSA-era). We used random effects modelling, except when no heterogeneity was present when we used fixed effects.

Results

We screened 1,968 records. Twelve were included (five RCTs, seven observational studies), representing 1,969 subjects. Seven enrolled from emergency departments, two from surgical clinics, and three from ambulatory clinics. Three enrolled children only. Pooled relative risk (RR) of treatment success among RCTs was 1.03 (95% confidence interval [CI] 0.97−1.08). Pooled RR in the secondary analyses was 1.05 (95% CI 0.96−1.15) in MRSA-only and 0.99 (95% CI 0.98−1.01) in MRSA-era.

Conclusion

Despite limitations in pooling available data, there is no clear evidence to support antibiotic use in treating uncomplicated SSTAs.

Objectif

L’étude visait à réaliser une revue systématique et une méta-analyse des études portant sur l’effet des antibiotiques dans le traitement des abcès de la peau et des tissus mous (APTM) après incision et évacuation.

Méthode

Une recherche a été entreprise dans les bases de données MEDLINE, EMBASE, Web of Knowledge et Google Scholar afin de relever des essais comparatifs à répartition aléatoire (ECRA) et des études d’observation. En ce qui concerne les ECRA, les études dans lesquelles il y avait une comparaison entre un traitement antibiotique quelconque (groupe expérimental) et un traitement placébo (groupe témoin) étaient retenues. En ce qui concerne les études d’observation, les traitements consistaient en l’utilisation appropriée d’antibiotiques efficaces contre des isolats de bactéries; et les interventions témoins, en l’utilisation non appropriée (inefficace) ou la non-utilisation d’antibiotiques. Le résultat recherché était la réussite du traitement pendant le suivi. Deux chercheurs ont passé en revue les documents relevés, évalué la qualité (selon les outils Cochrane et Newcastle-Ottawa) et dégagé les taux de réussite des traitements. L’analyse principale avait pour objet l’effet du traitement dans les ECRA; les analyses secondaires portaient sur l’effet du traitement dans: 1) les études d’observation de cas d’infection avérée à Staphylococcus aureus résistant à la méthicilline (SARM seul); 2) toutes les études menées après 1998 (époque des infections à SARM). Les auteurs ont eu recours au modèle à effets aléatoires, sauf dans les cas où le modèle à effets fixes ne décelait aucune hétérogénéité.

Résultats

Ont été relevés 1968 documents; 12 recherches (5 ECRA, 7 études d’observation) totalisant 1969 sujets ont été retenues. Dans 7 recherches, les patients provenaient de services d’urgence; dans 2 recherches, de centres ou de services de chirurgie; et dans 3 recherches, de services de soins ambulatoires. Trois recherches ne portaient que sur les enfants. Le risque relatif (RR) global de la réussite du traitement dans les ECRA était de 1,03 (CI à 95 %: 0,97−1,08), et celui dans les analyses secondaires, de 1,05 (CI à 95 %: 0,96−1,15) dans les cas de SARM seul, et de 0,99 (CI à 95 %: 0,98−1,01) dans les cas traités durant l’époque des infections à SARM.

Conclusion

Malgré les faiblesses de la réunion des données existantes, rien n’étaye l’emploi des antibiotiques dans le traitement des APTM sans complications.

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Corresponding author
Correspondence to: Dr. Jahan Fahimi, Department of Emergency Medicine, Alameda Health System, Highland Hospital, 1411 East 31st Street, Oakland, CA 94602; jahan.fahimi@ucsf.edu
References
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