A Randomized Clinical Trial Comparing Use of Rapid Molecular Testing for Staphylococcus aureus for Patients With Cutaneous Abscesses in the Emergency Department With Standard of Care. (26th August 2015)

• Record Type: Journal Article
• Authors: May, Larissa S.; Rothman, Richard E.; Miller, Loren G.; Brooks, Gillian; Zocchi, Mark; Zatorski, Catherine; Dugas, Andrea F.; Ware, Chelsea E.; Jordan, Jeanne A.
• Is Part Of: Infection control and hospital epidemiology. Volume 36:Number 12(2015)
• Page Start: 1423
• Page End: 1430
• Publication Date: 2015-08-26
• Subjects: Nosocomial infections -- Epidemiology -- Periodicals; Health facilities -- Sanitation -- Periodicals; Hospital buildings -- Sanitation -- Periodicals; Cross Infection -- Periodicals; Epidemiology -- Periodicals; Hospitals -- Periodicals; Infection Control -- Periodicals; 614.44
• DOI: 10.1017/ice.2015.202
• Languages: English
• ISSNs: 0899-823X

Abstract

Abstract : OBJECTIVE: To determine whether real-time availability of rapid molecular results of Staphylococcus aureus would impact emergency department clinician antimicrobial selection for adults with cutaneous abscesses. DESIGN: We performed a prospective, randomized controlled trial comparing a rapid molecular test with standard of care culture-based testing. Follow-up telephone calls were made at between 2 and 7 days, 1 month, and 3 months after discharge. SETTING: Two urban, academic emergency departments. PATIENTS: Patients at least 18 years old presenting with a chief complaint of abscess, cellulitis, or insect bite and receiving incision and drainage were eligible. Seven hundred seventy-eight people were assessed for eligibility and 252 met eligibility criteria. METHODS: Clinician antibiotic selection and clinical outcomes were evaluated. An ad hoc outcome of test performance was performed. RESULTS: We enrolled 252 patients and 126 were randomized to receive the rapid test. Methicillin-susceptible S. aureus –positive patients receiving rapid test results were prescribed beta-lactams more often than controls (absolute difference, 14.5% [95% CI, 1.1%–30.1%]) whereas methicillin-resistant S. aureus –positive patients receiving rapid test results were more often prescribed anti–methicillin-resistant S. aureus antibiotics (absolute difference, 21.5% [95% CI, 10.1%–33.0%]). There were no significant differences between the 2 groups in 1-week or 3-month clinical outcomes. CONCLUSION: Availability of rapid molecular test results after incision and drainage was associated with more-targeted antibiotic selection. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01523899 Infect. Control Hosp. Epidemiol. 2015;36(12):1423–1430