Hostname: page-component-89b8bd64d-x2lbr Total loading time: 0 Render date: 2026-05-13T06:28:18.599Z Has data issue: false hasContentIssue false
  • English
  • Français

A Randomized Clinical Trial Comparing Use of Rapid Molecular Testing for Staphylococcus aureus for Patients With Cutaneous Abscesses in the Emergency Department With Standard of Care

Published online by Cambridge University Press:  26 August 2015

Larissa S. May ,
Richard E. Rothman ,
Loren G. Miller ,
Gillian Brooks ,
Mark Zocchi ,
Catherine Zatorski ,
Andrea F. Dugas ,
Chelsea E. Ware  and
Jeanne A. Jordan
Larissa S. May*
Affiliation:
Emergency Department Antibiotic Stewardship, Department of Emergency Medicine, University of California–Davis, Sacramento, California
Richard E. Rothman
Affiliation:
Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland
Loren G. Miller
Affiliation:
Los Angeles BioMedical Research Center at Harbor-UCLA Medical Center, Torrance, California
Gillian Brooks
Affiliation:
Department of Emergency Medicine, George Washington University, Washington, DC
Mark Zocchi
Affiliation:
Office for Clinical Practice Innovation, George Washington University, Washington, DC
Catherine Zatorski
Affiliation:
Department of Emergency Medicine, George Washington University, Washington, DC
Andrea F. Dugas
Affiliation:
Los Angeles BioMedical Research Center at Harbor-UCLA Medical Center, Torrance, California
Chelsea E. Ware
Affiliation:
Department of Emergency Medicine, George Washington University, Washington, DC
Jeanne A. Jordan
Affiliation:
Department of Epidemiology and Biostatistics, School of Public Health, George Washington University, Washington, DC
*
Address correspondence to Larissa S. May, MD, University of California–Davis, Department of Emergency Medicine, 4150 V St, Ste 2100, Sacramento, CA 95817 (larissa.may@gmail.com).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To determine whether real-time availability of rapid molecular results of Staphylococcus aureus would impact emergency department clinician antimicrobial selection for adults with cutaneous abscesses.

DESIGN

We performed a prospective, randomized controlled trial comparing a rapid molecular test with standard of care culture-based testing. Follow-up telephone calls were made at between 2 and 7 days, 1 month, and 3 months after discharge.

SETTING

Two urban, academic emergency departments.

PATIENTS

Patients at least 18 years old presenting with a chief complaint of abscess, cellulitis, or insect bite and receiving incision and drainage were eligible. Seven hundred seventy-eight people were assessed for eligibility and 252 met eligibility criteria.

METHODS

Clinician antibiotic selection and clinical outcomes were evaluated. An ad hoc outcome of test performance was performed.

RESULTS

We enrolled 252 patients and 126 were randomized to receive the rapid test. Methicillin-susceptible S. aureus–positive patients receiving rapid test results were prescribed beta-lactams more often than controls (absolute difference, 14.5% [95% CI, 1.1%–30.1%]) whereas methicillin-resistant S. aureus–positive patients receiving rapid test results were more often prescribed anti–methicillin-resistant S. aureus antibiotics (absolute difference, 21.5% [95% CI, 10.1%–33.0%]). There were no significant differences between the 2 groups in 1-week or 3-month clinical outcomes.

CONCLUSION

Availability of rapid molecular test results after incision and drainage was associated with more-targeted antibiotic selection.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01523899

Infect. Control Hosp. Epidemiol. 2015;36(12):1423–1430

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 12 , December 2015 , pp. 1423 - 1430
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

1 Spellberg, B, Blaser, M, Guidos, RJ, et al.; Infectious Diseases Society of America (IDSA). Combating antimicrobial resistance: policy recommendations to save lives. Clin Infect Dis 2011;52:S397–S428.Google Scholar
2 Huletsky, A, Giroux, R, Rossbach, V, et al. New real-time PCR assay for rapid detection of methicillin-resistant Staphylococcus aureus directly from specimens containing a mixture of staphylococci. J Clin Microbiol 2004;42:1875–1884.Google Scholar
3 Renwick, L, Hardie, A, Girvan, EK, et al. Detection of methicillin-resistant Staphylococcus aureus and Panton-Valentine leukocidin directly from clinical samples and the development of a multiplex assay using real-time polymerase chain reaction. Eur J Clin Microbiol Infect Dis 2008;27:791–796.Google Scholar
4 Wassenberg, MW, Kluytmans, JA, Box, AT, et al. Rapid screening of methicillin-resistant Staphylococcus aureus using PCR and chromogenic agar: a prospective study to evaluate costs and effects. Clin Microbiol Infect 2010;16:1754–1761.CrossRefGoogle Scholar
5 Wolk, DM, Struelens, MJ, Pancholi, P, et al. Rapid detection of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) in wound specimens and blood cultures: multicenter preclinical evaluation of the Cepheid Xpert MRSA/SA skin and soft tissue and blood culture assays. J Clin Microbiol 2009;47:823–826.Google Scholar
6 Yang, S, Rothman, RE. PCR-based diagnostics for infectious diseases: uses, limitations, and future applications in acute-care settings. Lancet Infect Dis 2004;4:337–348.CrossRefGoogle ScholarPubMed
7 Polisena, J, Chen, S, Cimon, K, McGill, S, Forward, K, Gardam, M. Clinical effectiveness of rapid tests for methicillin-resistant Staphylococcus aureus (MRSA) in hospitalized patients: a systematic review. BMC Infect Dis 2011;11:336.CrossRefGoogle ScholarPubMed
8 May, L, Cosgrove, S, L’Archeveque, M, et al. A call to action for antimicrobial stewardship in the emergency department: approaches and strategies. Ann Emerg Med 2013;62:69–77.e2.Google Scholar
9 Terp, S, Krishnadasan, A, Bowen, W, et al. Introduction of rapid methicillin-resistant Staphylococcus aureus polymerase chain reaction testing and antibiotic selection among hospitalized patients with purulent skin infections. Clin Infect Dis 2014;58:e129–e132.Google Scholar
10 Elashoff, JD. nQuery Advisor Version 3.0 User’s Guide. Los Angeles, CA: Statistical Solutions, 1999.Google Scholar
11 May, L, Harter, K, Yadav, K, et al. Practice patterns and management strategies for purulent skin and soft-tissue infections in an urban academic ED. Am J Emerg Med 2012;30:302–310.Google Scholar
12 Cassell, GH, Mekalanos, J. Development of antimicrobial agents in the era of new and reemerging infectious diseases and increasing antibiotic resistance. JAMA 2001;285:601–605.Google Scholar
13 Schroeder, MS. Clostridium difficile–associated diarrhea. Am Fam Physician 2005;71:921–928.Google Scholar
14 Tilles, SA. Practical issues in the management of hypersensitivity reactions: sulfonamides. South Med J 2001;94:817–824.Google Scholar
15 Moran, GJ, Krishnadasan, A, Gorwitz, RJ, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355:666–674.CrossRefGoogle ScholarPubMed
16 Hammond, SP, Baden, LR. Clinical decisions: management of skin and soft-tissue infection—polling results. N Engl J Med 2008;359:e20.Google Scholar
17 Talan, DA, Krishnadasan, A, Gorwitz, RJ, et al. Comparison of Staphylococcus aureus from skin and soft-tissue infections in US emergency department patients, 2004 and 2008. Clin Infect Dis 2011;53:144–149.Google Scholar
18 Schmitz, GR. How do you treat an abscess in the era of increased community-associated methicillin-resistant Staphylococcus aureus (MRSA)? J Emerg Med 2011;41:276–281.Google Scholar
19 Duong, M, Markwell, S, Peter, J, Barenkamp, S. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pediatric patient. Ann Emerg Med 2010;55:401–407.Google Scholar
20 Rajendran, PM, Young, D, Maurer, T, et al. Randomized, double-blind, placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant Staphylococcus aureus infection. Antimicrob Agents Chemother 2007;51:4044–4048.CrossRefGoogle Scholar
21 Stevens, DL, Bisno, AL, Chambers, HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections: 2014 update by the Infectious Diseases Society of America [published correction appears in Clin Infect Dis 2015;60:1448]. Clin Infect Dis 2014;59:e10–e52.Google Scholar
22 Executive order—combating antibiotic-resistant bacteria. White House website. http://www.whitehouse.gov/the-press-office/2014/09/18/executive-order-combating-antibiotic-resistant-bacteria. Published September 14, 2014.Google Scholar
23 Tamma, P, Cosgrove, SE. Antimicrobial stewardship. Infect Dis Clin North Am 2011;25:245–260.Google Scholar
24 May, L, McCann, C, Brooks, G, Rothman, R, Miller, L, Jordan, J. Dual-site sampling improved detection rates for MRSA colonization in patients with cutaneous abscesses. Diagn Microbiol Infect Dis 2014;80:79–82.Google Scholar
25 May, L, Gudger, G, Armstrong, P, et al. Multisite exploration of clinical decision making for antibiotic use by emergency medicine providers using quantitative and qualitative methods. Infect Control Hosp Epidemiol 2014;35:1114–1125.Google Scholar