David A Talan1, Gregory J Moran2, Anusha Krishnadasan3, Fredrick M Abrahamian3, Frank Lovecchio4, David J Karras5, Mark T Steele6, Richard E Rothman7, William R Mower8. 1. Department of Emergency Medicine, Olive View-UCLA Medical Center, Los Angeles, CA; Department of Medicine, Division of Infectious Diseases, Olive View-UCLA Medical Center, Los Angeles, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: idnet@ucla.edu. 2. Department of Emergency Medicine, Olive View-UCLA Medical Center, Los Angeles, CA; Department of Medicine, Division of Infectious Diseases, Olive View-UCLA Medical Center, Los Angeles, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA. 3. Department of Emergency Medicine, Olive View-UCLA Medical Center, Los Angeles, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA. 4. Department of Emergency Medicine, Maricopa Medical Center, University of Arizona, and Mayo Graduate School of Medicine, Phoenix, AZ. 5. Department of Emergency Medicine, Temple University Medical Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA. 6. Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City School of Medicine, Kansas City, MO. 7. Department of Emergency Medicine, Johns Hopkins Medical Center, Johns Hopkins School of Medicine, Baltimore, MD. 8. Department of Emergency Medicine, Ronald Reagan Medical Center, Los Angeles, CA.
Abstract
STUDY OBJECTIVE: Two large randomized trials recently demonstrated efficacy of methicillin-resistant Staphylococcus aureus (MRSA)-active antibiotics for drained skin abscesses. We determine whether outcome advantages observed in one trial exist across lesion sizes and among subgroups with and without guideline-recommended antibiotic indications. METHODS: We conducted a planned subgroup analysis of a double-blind, randomized trial at 5 US emergency departments, demonstrating superiority of trimethoprim-sulfamethoxazole (320/1,600 mg twice daily for 7 days) compared with placebo for patients older than 12 years with a drained skin abscess. We determined between-group differences in rates of clinical (no new antibiotics) and composite cure (no new antibiotics or drainage) through 7 to 14 and 42 to 56 days after treatment among subgroups with and without abscess cavity or erythema diameter greater than or equal to 5 cm, history of MRSA, fever, diabetes, and comorbidities. We also evaluated treatment effect by lesion size and culture result. RESULTS: Among 1,057 mostly adult participants, median abscess cavity and erythema diameters were 2.5 cm (range 0.1 to 16.0 cm) and 6.5 cm (range 1.0 to 38.5), respectively; 44.3% grew MRSA. Overall, for trimethoprim-sulfamethoxazole and placebo groups, clinical cure rate at 7 to 14 days was 92.9% and 85.7%; composite cure rate at 7 to 14 days was 86.5% and 74.3%, and at 42 to 56 days, it was 82.4% and 70.2%. For all outcomes, across lesion sizes and among subgroups with and without guideline antibiotic criteria, trimethoprim-sulfamethoxazole was associated with improved outcomes. Treatment effect was greatest with history of MRSA infection, fever, and positive MRSA culture. CONCLUSION: Treatment with trimethoprim-sulfamethoxazole was associated with improved outcomes regardless of lesion size or guideline antibiotic criteria.
RCT Entities:
STUDY OBJECTIVE: Two large randomized trials recently demonstrated efficacy of methicillin-resistant Staphylococcus aureus (MRSA)-active antibiotics for drained skin abscesses. We determine whether outcome advantages observed in one trial exist across lesion sizes and among subgroups with and without guideline-recommended antibiotic indications. METHODS: We conducted a planned subgroup analysis of a double-blind, randomized trial at 5 US emergency departments, demonstrating superiority of trimethoprim-sulfamethoxazole (320/1,600 mg twice daily for 7 days) compared with placebo for patients older than 12 years with a drained skin abscess. We determined between-group differences in rates of clinical (no new antibiotics) and composite cure (no new antibiotics or drainage) through 7 to 14 and 42 to 56 days after treatment among subgroups with and without abscess cavity or erythema diameter greater than or equal to 5 cm, history of MRSA, fever, diabetes, and comorbidities. We also evaluated treatment effect by lesion size and culture result. RESULTS: Among 1,057 mostly adult participants, median abscess cavity and erythema diameters were 2.5 cm (range 0.1 to 16.0 cm) and 6.5 cm (range 1.0 to 38.5), respectively; 44.3% grew MRSA. Overall, for trimethoprim-sulfamethoxazole and placebo groups, clinical cure rate at 7 to 14 days was 92.9% and 85.7%; composite cure rate at 7 to 14 days was 86.5% and 74.3%, and at 42 to 56 days, it was 82.4% and 70.2%. For all outcomes, across lesion sizes and among subgroups with and without guideline antibiotic criteria, trimethoprim-sulfamethoxazole was associated with improved outcomes. Treatment effect was greatest with history of MRSA infection, fever, and positive MRSA culture. CONCLUSION: Treatment with trimethoprim-sulfamethoxazole was associated with improved outcomes regardless of lesion size or guideline antibiotic criteria.
Authors: Dennis L Stevens; Alan L Bisno; Henry F Chambers; E Patchen Dellinger; Ellie J C Goldstein; Sherwood L Gorbach; Jan V Hirschmann; Sheldon L Kaplan; Jose G Montoya; James C Wade Journal: Clin Infect Dis Date: 2014-07-15 Impact factor: 9.079
Authors: Catherine Liu; Arnold Bayer; Sara E Cosgrove; Robert S Daum; Scott K Fridkin; Rachel J Gorwitz; Sheldon L Kaplan; Adolf W Karchmer; Donald P Levine; Barbara E Murray; Michael J Rybak; David A Talan; Henry F Chambers Journal: Clin Infect Dis Date: 2011-01-04 Impact factor: 9.079
Authors: David A Talan; William R Mower; Anusha Krishnadasan; Fredrick M Abrahamian; Frank Lovecchio; David J Karras; Mark T Steele; Richard E Rothman; Rebecca Hoagland; Gregory J Moran Journal: N Engl J Med Date: 2016-03-03 Impact factor: 91.245
Authors: Michael C Lee; Ana M Rios; Monica Fonseca Aten; Asuncion Mejias; Dominick Cavuoti; George H McCracken; R Doug Hardy Journal: Pediatr Infect Dis J Date: 2004-02 Impact factor: 2.129