Subgroup Analysis of Antibiotic Treatment for Skin Abscesses

Details

• Alternative Title:
  Ann Emerg Med
• Personal Author:
  Talan, David A. ; Moran, Gregory J. ; Krishnadasan, Anusha ; Abrahamian, Fredrick M. ; Lovecchio, Frank ; Karras, David J. ; Steele, Mark T. ; Rothman, Richard E. ; Mower, William R.
• Description:
  Objective
  
  Two large randomized trials recently demonstrated efficacy of MRSA-active antibiotics for drained skin abscesses. We determine whether outcome advantages observed in one trial existed across lesion sizes and among subgroups with and without guideline recommended antibiotic indications.
  
  Design, Setting, and Participants
  
  We conducted a pre-planned subgroup analysis of a double-blind, randomized trial at 5 U.S. EDs demonstrating superiority of trimethoprim-sulfamethoxazole (320/1600 mg twice daily for 7 days) compared to placebo for patients >12 years of age with a drained skin abscess.
  
  Methods
  
  We determined between-group differences in rates of clinical (no new antibiotics) and composite cure (no new antibiotics or drainage) through 7–14 and 42–56 days after treatment among subgroups with and without abscess cavity or erythema diameter ≥5 cm, history of MRSA, fever, diabetes, and comorbidities. We also evaluated treatment effect by lesion size and culture result.
  
  Results
  
  Among 1057 mostly adult participants, median abscess cavity and erythema diameters were 2.5 cm (range, 0.1–16.0) and 6.5 cm (range, 1.0–38.5), respectively; 44.3% grew MRSA. Overall, for trimethoprim-sulfamethoxazole and placebo groups, clinical cure rate at 7–14 days was 92.9% and 85.7%, and composite cure rate at 7–14 was 86.5% and 74.3% and 82.4% and 70.2% at 42–56 days, respectively. For all outcomes, across lesion sizes and among subgroups with and without guideline antibiotic criteria, trimethoprim-sulfamethoxazole was associated with improved outcomes. Treatment effect was greatest with history of MRSA infection, fever, and MRSA etiology.
  
  Conclusions
  
  Treatment with trimethoprim-sulfamethoxazole was associated with improved outcomes regardless of lesion size or guideline antibiotic criteria.
  
  
• Subjects:
  Abscess Adolescent Adult Aged Anti-Bacterial Agents Antibiotics Article Double-Blind Method Drug Administration Schedule Female Follow-Up Studies Humans Male Methicillin-resistant Staphylococcus Aureus Middle Aged MRSA Randomized Skin Diseases, Bacterial Small Staphylococcal Skin Infections Streptococcal Infections Subgroup Treatment Outcome Trimethoprim, Sulfamethoxazole Drug Combination Trimethoprim-sulfamethoxazole Uncomplicated Young Adult

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• Source:
  Ann Emerg Med. 71(1):21-30
• Pubmed ID:
  28987525
• Pubmed Central ID:
  PMC5741525
• Document Type:
  Journal Article
• Funding:
  HHSN272200700032C/AI/NIAID NIH HHSUnited States/ ; U01 CI000353/CI/NCPDCID CDC HHSUnited States/ ; U01 CK000176/CK/NCEZID CDC HHSUnited States/
• Volume:
  71
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:a5720fd0b459c71aa77152f2880f8646aefe6d64d18998bd496e3a1b0da8231c
• Download URL:
  https://stacks.cdc.gov/view/cdc/131958/cdc_131958_DS1.pdf
• File Type:
  [PDF - 829.81 KB ]