Comparison of initial antibiotic choice and treatment of cellulitis in the pre- and post–community-acquired methicillin-resistant Staphylococcus aureus eras☆
Received 29 June 2007; received in revised form 16 March 2008; accepted 16 March 2008.
Abstract
Treatment success of cellulitis in the age of community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA). A comparison of initial antibiotic choice and treatment success in the pre- and post-CAMRSA eras.
Objective
The objective of this study is to determine antibiotic prescribing patterns and treatment failure rates for cellulitis in the pre- and post-CAMRSA eras.
Methods
We performed an electronic chart review of patients seen in our emergency department with cellulitis in 2000 and 2005. Inclusion criteria included age 18 years or more and received a single oral antibiotic for cellulitis. Exclusion criteria were incision and drainage, surgery, or admission on initial visit. Treatment failure was defined as a repeat visit in the subsequent 30 days and a change in antibiotics, admission to the hospital, incision and drainage of abscess, or surgical intervention. Antibiotic-prescribing practices and treatment failure rates were then compared in the pre- and post-CAMRSA eras.
Results
There was a significant decrease in β-lactam antibiotics and an increase in CAMRSA-effective antibiotics prescribed in 2005 vs 2000. The difference in treatment failure rates of the β-lactams and CAMRSA antibiotics was statistically insignificant. There has not been an increase in failure rates of the β-lactam antibiotics for simple cellulitis since the emergence of CAMRSA.
Conclusion
Our study demonstrates that prescribing practices for simple cellulitis have changed since the emergence of CAMRSA. This may not be appropriate because β-lactam antibiotics perform as well as ‘CAMRSA antibiotics’ in our study.
aDepartment of Emergency Medicine, Wilford Hall Medical Center, Lackland AFB, San Antonio, TX 78236, USA
bSan Antonio Uniformed Services Health Education Consortium, San Antonio, TX 78236, USA
cEmergency Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX 78236, USA
Corresponding author. Emergency Department, Ventura CMH, Ventura, CA 93003, USA. Tel.: +1 210 347 6715.
☆ All authored materials constitute the personal statements of Ryan Wells, MD; Phillip Mason, MD; Joseph Roarty, MD; and Melissa Dooley, MD and are not intended to constitute an endorsement by Wilford Hall Medical Center or any other Federal Government entity.
ABSTRACT