Abstract
Background
Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is now the leading cause of superficial abscesses seen in the Emergency Department.
Study Objectives
Our primary aim was to determine if an association exists between three predictor
variables (abscess size, cellulitis size, and MRSA culture) and treatment failure
within 7 days after incision and drainage in adults. Our secondary aim was to determine
if an association exists between two clinical features (abscess size and size of surrounding
cellulitis) and eventual MRSA diagnosis by culture.
Methods
Logistic regression models were used to examine clinical variables as predictors of
treatment failure within 7 days after incision and drainage and MRSA by wound culture.
Results
Of 212 study participants, 190 patients were analyzed and 22 were lost to follow-up.
Patients who grew MRSA, compared to those who did not, were more likely to fail treatment
(31% to 10%, respectively; 95% confidence interval [CI] 8–31%). The failure rates
for abscesses ≥ 5 cm and < 5 cm were 26% and 22%, respectively (95% CI −11–26%). The
failure rates for cellulitis ≥ 5 cm and < 5 cm were 27% and 16%, respectively (95%
CI −2–22%). Larger abscesses were no more likely to grow MRSA than smaller abscesses
(55% vs. 53%, respectively; 95% CI −22–23%). The patients with larger-diameter cellulitis
demonstrated a slightly higher rate of MRSA-positive culture results compared to patients
with smaller-diameter cellulitis (61% vs. 46%, respectively; 95% CI −0.3–30%), but
the difference was not statistically significant.
Conclusion
Cellulitis and abscess size do not predict treatment failures within 7 days, nor do
they predict which patients will have MRSA. MRSA-positive patients are more likely
to fail treatment within 7 days of incision and drainage.
Keywords
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Article info
Publication history
Published online: June 14, 2012
Accepted:
September 27,
2011
Received in revised form:
June 8,
2011
Received:
November 1,
2010
Footnotes
This article does not reflect the views of Brooke Army Medical Center, the United States Army, the Department of Defense, or the Federal Government.
Identification
Copyright
Published by Elsevier Inc.
