Author, year |
Study design |
Medical setting |
Patients (n) |
Primary outcome |
Microbiology |
Failure or recurrence rate |
Failure or recurrence definition |
Factors associated with treatment failure |
Abx |
Lee [37] |
Prospective |
14 primary care clinics |
106 |
Failure within 90 days from initial visit |
S. aureus |
Overall 22 of 106 (21%) (13 for MRSA, 9 for MSSA, P=0.7) |
Within 90 days of initial visit one of: new course or change in antibiotic therapy, additional incision or drainage, SSTI at a new site, SSTI at the same site, emergency department visit or hospital admission |
≥7 days duration of infection, lesion diameter size ≥5 cm |
76% TMP-SMX, 11% doxycycline, 7% clindamycin, 9% cephalexin (overall discordance 5%) |
Walsh [38] |
Retrospective |
2 academic medical centers |
163 |
Appropriateness of Abx treatment duration for SSTIs in hospitalized patients |
11 MSSA, 10 MRSA, 8 polymicrobial gram(+), 6 Streptococci, 4 other gram(+), 5 mixed gram (+) and gram (–), 3 gram (–) |
30-day readmission rate (6 of 163) |
30-day readmission secondary to recurrent SSTI |
ND |
ND |
Haran [39] |
Retrospective |
4 emergency departments |
467 |
Determine if age was associated with outpatient department treatment failure for purulent SSTI |
ND |
12.4% |
Need for change in Abx, surgical intervention or hospital admission within 30 days from emergency discharge |
Older age (>65 years), higher CCI score, infection involving hand structures and IV vancomycin at EDa |
Cephalosporin, clindamycin, doxycycline, vancomycin, metronidazole, TMP-SMX, fluoroquinolones and azithromycin |
Li [40] |
Retrospective |
4 hospitals of a healthcare conglomerate in China |
527 patients hospitalized with cSSTI |
Epidemiology and outcomes of patients hospitalized with cSSTI |
Available for 184 of 527 (32.5%). Gram (+) 61.41% (MRSA 7.6%), gram (–) 46.2% |
35 of 527 (6.64%) (20 of 527, 3.8% ≤3 months) |
Reinfection/recurrence |
ND |
Various |
Mistry [41] |
Retrospective |
Tertiary care hospital, ED department with 23-h OU |
192 children |
Clinical failure of OU treatment |
Available for 105 of 192 patients, 66.7% MRSA |
43 of 192 (22.4%) (primary reason for failure was ward admission for 98% of cases) |
One of: unexpected ward hospitalization directly from OU, return ED evaluation within 72 h after OU discharge, change in antibiotic therapy due to poor clinical response, need for incision and drainage after OU admission |
Fever on ED presentation, ultrasound performance in the ED prior to OU admission |
i.v Clindamycin 176, TMP-SMX 3, vancomycin 1, cefazolin 3 and other 4 |
May [42] |
Retrospective |
ED department |
197.371 |
Incidence and factors associated with ED visits for recurrent SSTI infections |
ND |
32.098 (16.3%) had at least one recurrence, 10.419 (5.3%) more than one recurrence |
Repeat SSTI, ED visit within 6 months from initial visit |
Nonsenior adults, female patients, non-Hispanic white patients, insurance status, geography and income, admitted patients, higher CCI, drug or alcohol abuse, liver disease, obesity, history of drainage or aspiration |
|
Hemmige [21] |
Retrospective |
Single center university of Chicago medical center's ID clinic |
85 |
Incidence and risk factors for recurrent SSTI among HIV patients |
Available for 23 of 85 (mostly S. aureus) |
30 of/85 (35.3%) at least one recurrent SSTI during follow up, 14 of 85 (16.5%) multiple recurrences |
Recurrent SSTI was defined as either an SSTI at a new site or recurrence at the original site greater than 30 days after the initial SSTI, with resolution of the signs and symptoms of the original infection in the interim |
Presence of intravascular catheter, nonhepatitis liver disease, lymphedema, history of IVDU and HIV VL>1000 c/ml |
20 combination therapy, 20 b lactam, 21 clindamycin, 8 TMP-SMX, 5 fluoroquinolones, 3 vancomycin and 3 no antimicrobials |
Macia-Rodriguez [43] |
Retrospective |
Single center university hospital |
308 hospitalized patients |
Factors associated with mortality and readmissions |
Local cultures performed for 144 patients, 95 of 144 were positive, 66 of 95 gram (+) (MRSA 11 of 66), 53 of 95 gram (–), 11 of 95 anaerobes |
34 of 308 readmitted for SSTI within 6 months from discharge |
Readmission for SSTI within 6 months from discharge |
Presence of malignancy and immunosuppression |
33.1% amoxicillin/clavulanate, 26% cloxacillin and 29.5% combination |
Eells [44] |
Prospective |
Tertiary care hospital |
87 patients with S. aureus skin infection without bacteremia, osteomyelitis, endocarditis or hardwareassociated infection |
Clinical response after 30 days of follow up |
S. aureus |
40 of 87 (46%) |
Any of the following: relapse of skin infection, new skin infection, receipt of prolonged antibiotic therapy for skin infection, receipt of new antibiotic therapy or change in therapy for skin infection, new incision and drainage |
Poor adherence to postdischarge antibiotic therapy, diabetes and illicit drug use |
46 TMP-SMX, 29 clindamycin, 4 amoxicillinclavulanate, 3 linezolid, 2 cephalexin, 1 dicloxacillin and 1 doxycycline |
May [45] |
Subanalysis of a parent study |
2 EDs |
Patients treated for a cutaneous abscess with incision and drainage. 193 completed either 1- or 3-month follow up |
Failure to improve within 1 week following initial treatment, SSTI recurrence at 1 and/or 3 months of treatment of the index infection |
27.5% MRSA, 18.7% MSSA, 47.7% other, 6.2% no growth/missing |
Combined SSTI recurrence occurred in 28% of 193 patients |
Failure defined as no change in/or increased pain, swelling, erythema, drainage of the current abscess or new or persistent fever. Recurrence defined as the presence of a new abscess at the same or different locations at least 2 weeks after resolution of the initial abscess |
Previous contact with someone infected with MRSA, history of SSTI within the past 12 months and clinician use of wound packing |
7.3% b lactams, 39.4% clindamycin, 17.6% TMP-SMX, 9.8% TMP-SMX + b lactams, 1% other and 24.9% none |
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