Krishan Yadav1,2, Avik Nath3, Kathryn N Suh4,5, Lindsey Sikora6, Debra Eagles3,5. 1. Department of Emergency Medicine, University of Ottawa, Ottawa, Canada. kyadav@toh.ca. 2. The Ottawa Hospital Civic Campus, Clinical Epidemiology Unit, Room F660b, 1053 Carling Avenue, Ottawa, ON, K1Y4E9, Canada. kyadav@toh.ca. 3. Department of Emergency Medicine, University of Ottawa, Ottawa, Canada. 4. Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Canada. 5. The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada. 6. Health Sciences Library, University of Ottawa, Ottawa, Canada.
Abstract
OBJECTIVE: There is currently no uniform definition for antimicrobial treatment failure for adults with non-purulent skin and soft tissue infections (SSTIs). The objective of this systematic review was to identify treatment failure definitions and their common components in the literature. METHODS: Five electronic databases were searched from inception to March 2019. Two independent reviewers identified studies involving adults (age ≥ 18 years) with non-purulent SSTIs in which antimicrobial treatment failure was a defined outcome. There were no language restrictions. Only randomized trials or observational studies were included. RESULTS: After screening 4953 abstracts, 26 studies (N = 6629 patients) met full inclusion criteria. Reported treatment failure ranged from 0 to 29.5%. The most common definition components were hospital admission (78.9%), change in antibiotics (65.4%), and persistent or worsening signs and symptoms of infection (34.6%). Only one study listed specific criteria for persistent or worsening signs and symptoms of infection. CONCLUSIONS: For studies involving non-purulent SSTIs, the outcome of treatment failure is inconsistently defined and reported failure rates are highly variable. This systematic review has highlighted the need for more robust treatment failure definitions for non-purulent SSTIs. Research should focus on the development of a uniform treatment failure definition that should be used in future studies.
OBJECTIVE: There is currently no uniform definition for antimicrobial treatment failure for adults with non-purulent skin and soft tissue infections (SSTIs). The objective of this systematic review was to identify treatment failure definitions and their common components in the literature. METHODS: Five electronic databases were searched from inception to March 2019. Two independent reviewers identified studies involving adults (age ≥ 18 years) with non-purulent SSTIs in which antimicrobial treatment failure was a defined outcome. There were no language restrictions. Only randomized trials or observational studies were included. RESULTS: After screening 4953 abstracts, 26 studies (N = 6629 patients) met full inclusion criteria. Reported treatment failure ranged from 0 to 29.5%. The most common definition components were hospital admission (78.9%), change in antibiotics (65.4%), and persistent or worsening signs and symptoms of infection (34.6%). Only one study listed specific criteria for persistent or worsening signs and symptoms of infection. CONCLUSIONS: For studies involving non-purulent SSTIs, the outcome of treatment failure is inconsistently defined and reported failure rates are highly variable. This systematic review has highlighted the need for more robust treatment failure definitions for non-purulent SSTIs. Research should focus on the development of a uniform treatment failure definition that should be used in future studies.
Authors: Krishan Yadav; Kathryn N Suh; Debra Eagles; Venkatesh Thiruganasambandamoorthy; George A Wells; Ian G Stiell Journal: Am J Emerg Med Date: 2019-02-21 Impact factor: 2.469
Authors: Emma Best; Alison Leversha; Sarah Primhak; Alicia Gataua; Diana Purvis; John M D Thompson; Cameron Walker Journal: Trials Date: 2022-02-02 Impact factor: 2.279