Guidelines vs Actual Management of Skin and Soft Tissue Infections in the Emergency Department.
Guidelines vs Actual Management of Skin and Soft Tissue Infections in the Emergency Department.
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DOI：
10.1093/ofid/ofx188
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发表时间：
2018-01
影响因子：
4.2
通讯作者：
Musher DM
中科院分区：
文献类型：
--
作者：
Kamath RS;Sudhakar D;Gardner JG;Hemmige V;Safar H;Musher DM
皮肤和软组织感染(SSTI)通常会导致去医院急诊科(ED)就诊。美国传染病学会(IDSA)已经发布了SSTI管理指南，但尚不清楚这些指南在实践中得到了多严格的遵守。我们回顾了一家大型三级护理医院急诊科就诊的患者的记录，以确定在4个重要方面遵守指南：住院决定、抗生素选择、脓肿切开和引流(I&D)以及提交标本进行培养。在19.6%的病例中，住院决定不符合指导方针。71%的非化脓性感染患者和68.4%的化脓性感染患者在急诊室开始使用非推荐抗生素。轻度脓肿几乎总是用抗生素治疗，而I&D经常不做(两者都违反了建议)。29%的轻、重度蜂窝组织炎患者进行了血培养(违反建议)。脓肿引流几乎总是送去培养(建议既不赞成也不反对)。总体而言，20.1%的病例治疗完全符合指南。我们的结果显示，在SSTI的ED管理中，明显缺乏与IDSA指南的一致性。社会因素可能是关于护理地点的不一致决定的原因。在蜂窝组织炎中使用甲氧苄啶/磺胺甲恶唑(TMP/SMX)是最常见的不一致来源；一些医学文献支持这种做法。蜂窝组织炎和单纯性脓肿I&D后经常使用过量的抗生素，反对抗生素管理。需要对急诊医生进行持续的教育，并继续审查已公布的指南。
Infections of skin and soft tissue (SSTI) commonly cause visits to hospital emergency departments (EDs). The Infectious Diseases Society of America (IDSA) has published guidelines for the management of SSTI, but it is unclear how closely these guidelines are followed in practice. We reviewed records of patients seen in the ED at a large tertiary care hospital to determine guidelines adherence in 4 important areas: the decision to hospitalize, choice of antibiotics, incision and drainage (I&D) of abscesses, and submission of specimens for culture. The decision to hospitalize did not comply with guidelines in 19.6% of cases. Nonrecommended antibiotics were begun in the ED in 71% of patients with nonpurulent infections and 68.4% of patients with purulent infections. Abscesses of mild severity were almost always treated with antibiotics, and I&D was often not done (both against recommendations). Blood cultures were done (against recommendations) in 29% of patients with mild-severity cellulitis. Abscess drainage was almost always sent for culture (recommendations neither favor nor oppose). Overall, treatment fully complied with guidelines in 20.1% of cases. Our results show a striking lack of concordance with IDSA guidelines in the ED management of SSTI. Social factors may account for discordant decisions regarding site of care. Use of trimethoprim/sulfamethoxazole (TMP/SMX) in cellulitis was the most common source of discordance; this practice is supported by some medical literature. Excess antibiotics were often used in cellulitis and after I&D of simple abscesses, opposing antibiotic stewardship. Ongoing education of ED doctors and continued review of published guidelines are needed.
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DOI：
10.1056/nejmoa1403789
发表时间：
2015-03-19
期刊：
The New England journal of medicine
影响因子：
--
作者：
Miller LG;Daum RS;Creech CB;Young D;Downing MD;Eells SJ;Pettibone S;Hoagland RJ;Chambers HF;DMID 07-0051 Team
通讯作者：
DMID 07-0051 Team
影响因子：
3.1
作者：
Pallin, Daniel J.;Camargo, Carlos A., Jr.;Schuur, Jeremiah D.
通讯作者：
Schuur, Jeremiah D.
影响因子：
28.2
作者：
Figtree, M.;Konecny, P.;Miyakis, S.
通讯作者：
Miyakis, S.
影响因子：
2.6
作者：
Yarbrough, Peter M.;Kukhareva, Polina V.;Kawamoto, Kensaku
通讯作者：
Kawamoto, Kensaku
影响因子：
5.2
作者：
Marwick, Charis;Rae, Nikolas;Davey, Peter
通讯作者：
Davey, Peter