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.
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.
复制标题
DOI：
10.1017/ice.2015.202
复制
发表时间：
2015-12
影响因子：
4.5
通讯作者：
Jordan JA
中科院分区：
文献类型：
--
作者：
May LS;Rothman RE;Miller LG;Brooks G;Zocchi M;Zatorski C;Dugas AF;Ware CE;Jordan JA
确定金黄色葡萄球菌快速分子结果的实时可用性是否会影响急诊科临床医生对皮肤脓肿成人的抗菌药物选择。我们进行了一项前瞻性随机对照试验，比较快速分子检测与基于培养的标准护理检测。在出院后2 - 7天、1个月和3个月进行电话随访。两个市区，学术急诊室。患者年龄至少18岁，主诉脓肿、蜂窝织炎或昆虫叮咬，接受切开引流。778人接受了资格评估，252人符合资格标准。评价临床医生抗生素选择和临床结局。进行了测试性能的特别结果。我们招募了252名患者，其中126名随机接受快速检测。对甲氧西林敏感的S.接受快速检测结果的金黄色葡萄球菌阳性患者比对照组更常使用β-内酰胺类药物（绝对差异，14.5% [95%CI，1.1%-30.1%]），而耐甲氧西林的S.接受快速检测结果的金黄色葡萄球菌阳性患者更常被处方抗甲氧西林耐药S。金黄色葡萄球菌抗生素（绝对差异，21.5% [95% CI，10.1%-33.0%]）。两组在1周或3个月的临床结局方面无显著差异。切开和引流后快速分子检测结果的可用性与更具针对性的抗生素选择相关。clinicaltrials.gov标识符：NCT 01523899
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. 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. Two urban, academic emergency departments. 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. Clinician antibiotic selection and clinical outcomes were evaluated. An ad hoc outcome of test performance was performed. 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. Availability of rapid molecular test results after incision and drainage was associated with more-targeted antibiotic selection. clinicaltrials.gov Identifier: NCT01523899