High Treatment Failure Rates Among Elderly With Purulent Skin Infections

MedicalResearch.com Interview with:

John P. Haran, MD Assistant Professor Department of Emergency Medicine University of Massachusetts Medical School UMass Memorial Medical Group Worcester, MA

Dr. John P. Haran

John P. Haran, MD
Assistant Professor
Department of Emergency Medicine
University of Massachusetts Medical School
UMass Memorial Medical Group
Worcester, MA

MedicalResearch.com: What is the background for this study?

Response: In 2014, the Infectious Disease Society of America (IDSA) updated their guidelines for the management of skin and soft tissue infection in response to high MRSA infection rates as well as high treatment failure rates for skin and soft tissue infections. Greater than 1 in 5 patients treated for a skin abscess will fail initial treatment.

Historically antibiotics have been shown to be unnecessary in the treatment of uncomplicated purulent infections. This notion has been recently challenges when authors published a randomized control trial using trimethoprim-sulfamethoxazone in the NEJM that demonstrated a minimal increase in cure rates for outpatient treatment of uncomplicated skin purulent skin infections. In this study they did not follow IDSA-guidelines nor model or stratify their analysis. It is possible their findings may be due to at-risk patient groups that did not receive antibiotics. Many widely used clinical decision rules incorporate age into their decision algorithms, however the IDSA did not do this with their recent guidelines.

MedicalResearch.com: What are the main findings?

Response: What we discovered was that treatment failure of ED patients that present with a purulent skin infection was significantly associated with advanced age with elderly patients having almost 4 times the increased risk of treatment failure compared to their younger counterparts. This risk increased to more than 8 times among patients with confirmed purulent skin infections (i.e. they had an incision and drainage completed during their visit). There was no difference in failures across the three IDSA classifications (mild, moderate, and severe) nor if the patient was treated following IDSA guidelines or either over or under-treated.

MedicalResearch.com: What should readers take away from your report?

Response: The IDSA developed their practice guidelines in order to diagnose and administer effective treatments in a timely fashion. By not including age in their treatment algorithm, the IDSA might be under-treating older adults who carry greater risk of morbidity from bacterial skin infections. The high treatment failure rates among the elderly raises concerns and further work is need to determine if we should base antibiotic adjunct therapy off of age.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Based on our findings, we recommend that in outpatient treatment of purulent skin infections elderly patients may warrant adjuvant therapy with antibiotics. Further work is needed determine the best treatment modalities for our elderly patients with a purulent skin infection. This would include randomized controlled trials aimed at at-risk vulnerable populations that fail initial therapy at higher rates (including the elderly). Targeting adjunct antibiotic treatments for skin abscesses would reducing unnecessary outpatient antibiotics among patients with uncomplicated purulent infections and would be a critical modality to combat the growing bacterial antibiotic resistance epidemic we are facing. Finally, treatment guidelines should take the age of the patient into consideration to improve cure rates and possibly target antibiotic therapy to those at increased risk of treatment failure.

MedicalResearch.com: Is there anything else you would like to add?

Response: Thank you for your time and interest in this important topic area.

Citation:
Elderly patients are at increased risk for treatment failure in outpatient management of purulent skin infections Haran, John P. et al.
The American Journal of Emergency Medicine , Volume 0 , Issue 0 ,
DOI: http://dx.doi.org/10.1016/j.ajem.2016.10.060
ublished online:October 28, 2016

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