Madaras-Kelly Karl J, Remington Richard E, Oliphant Catherine M, Sloan Kevin L, Bearden David T
College of Pharmacy, Idaho State University, Boise, Idaho, USA.
Am J Med. 2008 May;121(5):419-25. doi: 10.1016/j.amjmed.2008.01.028.
Preferred therapy for purulent skin and soft tissue infections is incision and drainage, but many infections cannot be drained. Empiric therapies for these infections are ill-defined in the era of community-acquired methicillin-resistant Staphylococcus aureus.
A multicenter retrospective cohort study of outpatients treated for cellulitis was conducted to compare clinical failure rates of oral beta-lactam and non-beta-lactam treatments. Exclusion criteria included purulent infection requiring incision and drainage, complicated skin and soft tissue infection, chronic ulceration, and intravenous antibiotics. Failure rates were compared using logistic regression to adjust for both covariates associated with failure and a propensity score for beta-lactam treatment.
Of 2977 patients, 861 met inclusion criteria and were classified by treatment: beta-lactam (n = 631) or non-beta-lactam therapy (n = 230). Failure rates were 14.7% versus 17.0% (odds ratio [OR] 0.85, 95% confidence interval [CI], 0.56-1.31) for beta-lactam and non-beta-lactam therapy, respectively. Failure was associated with: age (P = .02), acute symptom severity (P = .03), animal bites (P = .03), Charlson score > 3 (P = .02), and histamine-2 receptor antagonist use (P = .09). Relative efficacy of beta-lactam therapy was greater after adjustment for factors associated with failure but remained statistically insignificant (adjusted OR 0.81, 95% CI, 0.53-1.24); adjusted including propensity score covariate (OR 0.71, 95% CI, 0.45-1.13). Discontinuation due to adverse effects differed between beta-lactam (0.5%) and non-beta-lactam (2.2%) therapies (P = .04).
There was no significant difference in clinical failure between beta-lactam and non-beta-lactam antibiotics for the treatment of uncomplicated cellulitis. Increased discontinuation due to adverse events with non-beta-lactam therapy was observed.
化脓性皮肤和软组织感染的首选治疗方法是切开引流，但许多感染无法引流。在社区获得性耐甲氧西林金黄色葡萄球菌时代，这些感染的经验性治疗方法尚不明确。
进行了一项针对蜂窝织炎门诊患者的多中心回顾性队列研究，以比较口服β-内酰胺类药物和非β-内酰胺类药物治疗的临床失败率。排除标准包括需要切开引流的化脓性感染、复杂的皮肤和软组织感染、慢性溃疡以及静脉使用抗生素。使用逻辑回归比较失败率，以调整与失败相关的协变量和β-内酰胺类药物治疗的倾向评分。
2977例患者中，861例符合纳入标准，并根据治疗方法分类：β-内酰胺类药物治疗组（n = 631）和非β-内酰胺类药物治疗组（n = 230）。β-内酰胺类药物治疗组和非β-内酰胺类药物治疗组的失败率分别为14.7%和17.0%（优势比[OR] 0.85，95%置信区间[CI]，0.56 - 1.31）。失败与以下因素相关：年龄（P = .02）、急性症状严重程度（P = .03）、动物咬伤（P = .03）、查尔森评分> 3（P = .02）以及使用组胺-2受体拮抗剂（P = .09）。在调整与失败相关的因素后，β-内酰胺类药物治疗的相对疗效更高，但仍无统计学意义（调整后OR 0.81，95% CI，0.53 - 1.24）；调整包括倾向评分协变量（OR 0.71，95% CI，0.45 - 1.13）。因不良反应停药的情况在β-内酰胺类药物治疗组（0.5%）和非β-内酰胺类药物治疗组（2.2%）之间存在差异（P = .04）。
在治疗单纯性蜂窝织炎时，β-内酰胺类抗生素和非β-内酰胺类抗生素的临床失败率无显著差异。观察到非β-内酰胺类药物治疗因不良事件导致的停药率增加。
