Antimicrobial Stewardship Through MRSA Diagnosis in Emergency Department (ED) Patients With Abscesses

George Washington University252 enrolled

Overview

This study expands upon pilot data for feasibility since May 2011. The study aims to evaluate the effect of rapid test availability on use of targeted spectrum antibiotics for non-MRSA abscesses in ambulatory patients in the Emergency Department (ED). The multi-institutional study will assess the feasibility of providing the GeneXpert® MRSA/SA SSTI assay to the ED and evaluate the impact of delivering the test result to clinicians in real-time on patient management decisions regarding the use of antimicrobial agents. Patients are randomized to standard culture (control arm) or to the GeneXpert® assay plus standard culture.

Our objective was to determine whether real-time availability of rapid molecular results of Staphylococcus aureus would impact emergency department clinician antimicrobial selection for adults with cutaneous abscesses. We performed a prospective, randomized controlled trial in two urban emergency departments comparing a rapid molecular test with standard of care culture-based testing. Follow-up telephone calls were made at between 2 and 7 days, 1 month, and 3 months after discharge. Patients at least 18 years old presenting with a chief complaint of abscess, cellulitis, or insect bite and receiving incision and drainage were eligible. Seven hundred seventy-eight people were assessed for eligibility and 252 met eligibility criteria.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

252

Conditions

Cutaneous Abscess

Interventions

Xpert MRSA/SA SSTIDEVICE

Use of Xpert MRSA/SA SSTI assay

Standard cultureDIAGNOSTIC_TEST

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * adults 18 years or older with community onset abscess Exclusion Criteria: * previous treatment for same abscess in past 14 days * postoperative infection * inability to provide informed consent

Locations (2)

The George Washington University

Washington D.C., District of Columbia, United States

Johns Hopkins University

Baltimore, Maryland, United States

Outcomes

Primary Outcomes

Number of Participants With Antibiotic Usage at the Time of the ED Visit

Number of Participants with Antibiotic Usage at the time of the ED visit (narrow spectrum, broad spectrum, or none) will be recorded at the time of the ED visit

Time frame: Baseline

Secondary Outcomes

Participant Clinical Improvement Post-treatment at One Week

clinical improvement (decreasing erythema, pain, swelling, drainage, and presence or absence of fever) will be documented at 2-7 day phone follow up and 1 and 3 months

Time frame: 2 to 7 days

Clinical Outcome at One or Three Months

Recurrence of abscess within a three month time period

Time frame: 3 months

Data from ClinicalTrials.gov

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