Trimethoprim-Sulfamethoxazole Therapy Reduces Failure and Recurrence in Methicillin-Resistant Staphylococcus aureus Skin Abscesses after Surgical Drainage

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• 作者：Lucy Holmes ; MD¹ ; ² ; ^{LHolmes@upa.chob.edu" class="auth_mail" title="E-mail the corresponding author} ; Changxing Ma ; PhD¹ ; Haiping Qiao ; MBBS ; MS² ; Cheryl Drabik ; MSN² ; Colleen Hurley ; MSN² ; Donna Jones ; MS² ; Sarah Judkiewicz ; MSN² ; Howard Faden ; MD¹ ; ²
• 关键词：CA ; Community-associated ; ED ; Emergency department ; MRSA ; Methicillin-resistant Staphylococcus aureus ; MSSA ; Methicillin-sensitive Staphylococcus aureus ; SSTI ; Skin and soft-tissue infection ; TMP-SMX ; Trimethoprim-sulfamethoxazole
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：169
• 期：Complete
• 页码：128-134.e1
• 全文大小：315 K

文摘

To determine whether a 3-day vs 10-day course of antibiotics after surgical drainage of skin abscesses is associated with different failure and recurrence rates.

Study design

ara0015">Patients age 3 months to 17 years seeking care at a pediatric emergency department with an uncomplicated skin abscess that required surgical drainage were randomized to receive 3 or 10 days of oral trimethoprim-sulfamethoxazole therapy. Patients were evaluated 10-14 days later to assess clinical outcome. Patients were followed for 6 months to determine the cumulative rate of recurrent skin infections.

Results

ara0020">Among the 249 patients who were enrolled, 87% of wound cultures grew Staphylococcus aureus (S aureus) (55% methicillin-resistant S aureus [MRSA], 32% methicillin-sensitive S aureus), 11% other organisms, and 2% no growth. Thirteen patients experienced treatment failure. Among all patients, no significant difference in failure rates between the 3- and 10-day treatment groups was found. After we stratified patients by the infecting organism, only patients with MRSA infection were more likely to experience treatment failure in the 3-day group than the 10-day group (P = .03, rate difference 10.1%, 95% CI 2.1%-18.2%) Recurrent infection within 1 month of surgical drainage was more likely in patients infected with MRSA who received 3 days of antibiotics. (P = .046, rate difference 10.3%, 95% CI 0.8%-19.9%).

Conclusion

ara0025">Patients with MRSA skin abscesses are more likely to experience treatment failure and recurrent skin infection if given 3 rather than 10 days of trimethoprim-sulfamethoxazole after surgical drainage.

Trial registration

ara0030">ClinicalTrials.gov: NCT02024867.