| Emergency management of pediatric skin and soft tissue infections in the community-associated methicillin-resistant Staphylococcus aureus era. | |
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MedLine Citation:
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PMID: 20370748 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Skin and soft tissue infections (SSTIs) are increasing in incidence, yet there is no consensus regarding management of these infections in the era of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). This study sought to describe current pediatric emergency physician (PEP) management of commonly presenting skin infections. METHODS: This was a cross-sectional survey of subscribers to the American Academy of Pediatrics Section on Emergency Medicine (AAP SoEM) list-serv. Enrollment occurred via the list-serv over a 3-month period. Vignettes of equivocal SSTI, cellulitis, and skin abscess were presented to participants, and knowledge, diagnostic, and therapeutic approaches were assessed. RESULTS: In total, 366 of 606 (60.3%) list-serv members responded. The mean (+/- standard deviation [SD]) duration of practice was 13.6 (+/-7.9) years, and 88.6% practiced in a pediatric emergency department. Most respondents (72.7%) preferred clinical diagnosis alone for equivocal SSTI, as opposed to invasive or imaging modalities. For outpatient cellulitis, PEPs selected clindamycin (30.6%), trimethoprim-sulfa (27.0%), and first-generation cephalosporins (22.7%); methicillin-sensitive S. aureus (MSSA) was routinely covered, but many regimens failed to cover CA-MRSA (32.5%) or group A streptococcus (27.0%). For skin abscesses, spontaneous discharge (67.5%) was rated the most important factor in electing to perform a drainage procedure; fever (19.9%) and patient age (13.1%) were the lowest. PEPs elected to prescribe trimethoprim-sulfamethoxazole (TMP-Sx; 50.0%) or clindamycin (32.7%) after drainage; only 5% selected CA-MRSA-inactive agents. All PEPs suspected CA-MRSA as the etiology of skin abscesses, and many attributed sepsis (22.1%) and invasive pneumonia (20.5%) to CA-MRSA, as opposed to MSSA. However, 23.9% remained unaware of local CA-MRSA prevalence for even common infections. CONCLUSIONS: Practice variation exists among PEPs for management of SSTI. These results can be used to measure changes in SSTI practices as standardized approaches are delineated. |
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Authors:
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Rakesh D Mistry; Keith Weisz; Halden F Scott; Elizabeth R Alpern |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Volume: 17 ISSN: 1553-2712 ISO Abbreviation: Acad Emerg Med Publication Date: 2010 Feb |
Date Detail:
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Created Date: 2010-04-07 Completed Date: 2010-08-09 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9418450 Medline TA: Acad Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 187-93 Citation Subset: IM |
Copyright Information:
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(c) 2010 by the Society for Academic Emergency Medicine. |
Affiliation:
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Department of Pediatrics and the Division of Emergency Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. mistryr@email.chop.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anti-Bacterial Agents / therapeutic use* Cellulitis / therapy Clindamycin / therapeutic use Community-Acquired Infections Cross-Sectional Studies Emergency Medical Services Health Care Surveys Humans Methicillin-Resistant Staphylococcus aureus Physician's Practice Patterns / statistics & numerical data* Skin Diseases, Infectious / drug therapy* Soft Tissue Infections / drug therapy* |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents; 18323-44-9/Clindamycin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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