Department of Family Medicine, University of Colorado Denver, Aurora, Colorado, USA.
J Am Board Fam Med. 2011 Sep-Oct;24(5):534-42. doi: 10.3122/jabfm.2011.05.110018.
Purulent skin and soft tissue infections (SSTIs) requiring medical attention are often managed in primary care. The prevalence of SSTIs caused by community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) has been increasing rapidly, including in otherwise healthy individuals. The Centers for Disease Control and Prevention (CDC) issued guidelines to improve the management of SSTIs in primary care.
In primary care settings, to assess the prevalence of CA-MRSA using an electronic chart audit and then evaluate SSTI management strategies consistent with CDC guidelines.
A practical intervention that compared a historical cohort to an intervention cohort of patients seen for SSTI in 16 primary care practices in two health care systems. The intervention included a ready-made kit for I & D procedures, MRSA information for clinicians, a patient information handout, provider education, and patient follow-up.
A total of 3112 SSTI cases (cellulitis or purulent) were observed during the preintervention period and 1406 cases during the intervention. For purulent infections in the intervention period (n = 148), univariate and multivariate analyses showed no significant improvement in the rate of I & D procedures or cultures obtained but showed increased use of antibiotics overall and agents that typically cover MRSA strains (OR, 2.183; 95% CI, 1.443 to 3.303 and 2.624; 95% CI, 1.500 to 4.604, respectively). For infections that were cellulitis with or without purulence (n = 1258), overall rates in the use of antibiotics and those that cover MRSA increased significantly, but secular trends could not be ruled out as an explanation for this increase.
In SSTIs, this intervention resulted in increased use of antibiotics, including antibiotics that typically cover MRSA strains, but did not demonstrate increased rates of recommended drainage procedures. It is replicable and portable, and may improve antibiotic selection in other settings.
需要医疗关注的脓性皮肤和软组织感染（SSTIs）通常在初级保健中进行管理。社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）引起的 SSTIs 的患病率一直在迅速增加，包括在原本健康的个体中。疾病控制与预防中心（CDC）发布了指南，以改善初级保健中 SSTIs 的管理。
在初级保健环境中，使用电子图表审计评估 CA-MRSA 的患病率，然后评估符合 CDC 指南的 SSTI 管理策略。
这是一项实用的干预措施，比较了两个医疗保健系统的 16 个初级保健实践中 SSTI 就诊的历史队列和干预队列。该干预措施包括用于切开和引流（I&D）程序的现成套件、临床医生的 MRSA 信息、患者信息传单、提供者教育和患者随访。
在干预前期间观察到 3112 例 SSTI 病例（蜂窝织炎或脓性），在干预期间观察到 1406 例。在干预期间的脓性感染（n=148）中，单变量和多变量分析显示 I&D 程序或获得的培养物的比率没有显著改善，但总体上抗生素的使用增加了，并且通常覆盖 MRSA 菌株的抗生素也增加了（比值比，2.183；95%置信区间，1.443 至 3.303 和 2.624；95%置信区间，1.500 至 4.604）。对于有或没有脓性的蜂窝织炎感染（n=1258），抗生素和覆盖 MRSA 的抗生素的总体使用率显著增加，但不能排除这种增加是由于时间趋势造成的。
在 SSTIs 中，这种干预措施导致抗生素的使用增加，包括通常覆盖 MRSA 菌株的抗生素，但没有显示出推荐引流程序的比率增加。它是可复制和可移植的，并可能改善其他环境中的抗生素选择。
