Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada.
CJEM. 2022 Nov;24(7):719-724. doi: 10.1007/s43678-022-00366-1. Epub 2022 Sep 27.
Current guidelines suggest adjuvant antibiotics after incision and drainage (I&D) of small, uncomplicated abscesses may improve patient outcomes, minimize pain, and prevent recurrence. The objective was to explore antibiotic prescribing at ED discharge and describe patient outcomes.
This was a health records review of adult patients (≥ 18 years) discharged from an academic hospital ED (annual census 65,000) over a 2-year period with diagnosis of an uncomplicated skin abscess. Outcomes included any unplanned return ED visits within 30 days, repeat I&D, and escalation to intravenous (IV) antibiotics.
Of 389 ED visits, 85.6% patients underwent I&D, of which 62.2% were prescribed antibiotics at discharge. Of these patients, 36.7% received guideline recommended antibiotics (TMP-SMX or clindamycin). Of all patients who underwent I&D, 13.2% had an unplanned return ED visit within 30 days, 6.9% required repeat I&D, and 0.6% patients were escalated to IV antibiotics. Patients treated with cefalexin were more likely to have an unplanned return ED visit within 30 days (20.0 vs 5.3%; Δ14.7, 95% CI 4.6-24.4), and were more likely to have a repeat I&D within 30 days (13.7 vs 0%; Δ13.7, 95% CI 6.4-22.0), compared to patients prescribed guideline recommended antibiotics. Treatment with guideline recommended antibiotics reduced treatment failure significantly in MRSA positive patients (0.0 vs 44.4%; Δ44.4, 95% CI 13.4-73.3).
Antibiotics were prescribed for most abscesses that underwent I&D. Less than half of the patients received antibiotics that were guideline recommended. Compared to those who received cefalexin, patients prescribed TMP-SMX or clindamycin had fewer return ED visits and were less likely to have a repeat I&D within 30 days. However, adjuvant antibiotic use did not significantly improve outcomes overall, with most patients not requiring a change in management irrespective of antibiotic use.
目前的指南建议，对小而简单的脓肿进行切开引流（I&D）后使用辅助抗生素可以改善患者的预后，减轻疼痛并预防复发。目的是探讨急诊科（ED）出院时的抗生素开具情况，并描述患者的结局。
这是一项对 2 年内在学术医院 ED 就诊（每年普查 65000 人）且诊断为单纯皮肤脓肿的成年患者（≥18 岁）的病历回顾性研究。结果包括 30 天内有无计划的再次 ED 就诊、再次 I&D 和升级为静脉（IV）抗生素。
在 389 次 ED 就诊中，85.6%的患者接受了 I&D，其中 62.2%的患者在出院时开具了抗生素。在这些患者中，36.7%的患者接受了指南推荐的抗生素（复方磺胺甲噁唑或克林霉素）。所有接受 I&D 的患者中，13.2%在 30 天内有无计划的再次 ED 就诊，6.9%需要再次 I&D，0.6%的患者升级为 IV 抗生素。使用头孢氨苄的患者在 30 天内再次 ED 就诊的可能性更高（20.0%比 5.3%；Δ14.7，95%CI 4.6-24.4），在 30 天内再次接受 I&D 的可能性也更高（13.7%比 0%；Δ13.7，95%CI 6.4-22.0），与接受指南推荐抗生素的患者相比。在 MRSA 阳性患者中，使用指南推荐的抗生素可显著降低治疗失败率（0.0%比 44.4%；Δ44.4，95%CI 13.4-73.3）。
大多数接受 I&D 的脓肿患者都开具了抗生素。不到一半的患者接受了指南推荐的抗生素。与使用头孢氨苄的患者相比，使用复方磺胺甲噁唑或克林霉素的患者在 30 天内再次 ED 就诊的次数更少，再次 I&D 的可能性也更小。然而，辅助抗生素的使用并不能显著改善整体结局，大多数患者无论是否使用抗生素，都不需要改变治疗方案。
