HHS Public Access Author manuscript Author Manuscript
Acad Emerg Med. Author manuscript; available in PMC 2016 August 01. Published in final edited form as: Acad Emerg Med. 2015 August ; 22(8): 993–997. doi:10.1111/acem.12727.
Microbiology and Initial Antibiotic Therapy for Injection Drug Users and Non-Injection Drug Users with Cutaneous Abscesses in the Era of Community-Associated Methicillin-Resistant Staphylococcus aureus
Author Manuscript
Timothy C. Jenkins, MD1,2,5,6, Bryan C. Knepper, MPH, MSc3, S. Jason Moore, PhD, PA7, Carla C. Saveli, MD5,6, Sean W. Pawlowski, MD8, Daniel M. Perlman, MD, MBA9, Bruce D. McCollister, MD5,6,10,11, and William J. Burman, MD1,2,4,5,6 1Department 2Division
of Infectious Diseases, Denver Health, Denver, Colorado
3Department 4Denver
of Medicine, Denver Health, Denver, Colorado
of Patient Safety and Quality, Denver Health, Denver, Colorado
Public Health, Denver Health, Denver, Colorado
5Department 6Division
of Medicine, University of Colorado School of Medicine, Aurora, Colorado
of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
7Department
Author Manuscript
8Colorado
of Trauma and Critical Care Services, Vail Valley Medical Center, Vail, Colorado
Infectious Disease Associates, Denver, Colorado
9Department
of Medicine, Porter Adventist Medical Center, Denver, Colorado
10Department 11Division
of Medicine, Denver Veterans Affairs Medical Center, Denver, Colorado
of Infectious Diseases, Denver Veterans Affairs Medical Center, Denver, Colorado
Abstract
Author Manuscript
Objectives—The incidence of cutaneous abscesses has increased markedly since the emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Injection drug use is a risk factor for abscesses and may impact the microbiology and treatment of these infections. In a cohort of patients hospitalized with cutaneous abscesses in the era of CA-MRSA, our objectives were to: 1) compare the microbiology of abscesses between injection drug users and non-injection drug users, and 2) evaluate antibiotic therapy started in the emergency department in relation to microbiological findings and national guideline treatment recommendations.
Corresponding author: Timothy C. Jenkins, MD, 660 Bannock Street, Denver, Colorado 80204, Office: 303-602-5041, Fax: 303-602-5055, [email protected]. Prior presentations: This work was presented in part at ID Week 2014, October 8 – 12th, Philadelphia, PA Disclosures Potential conflicts of interest: TCJ: Durata Therapeutics. DMP: Optimer, Cubist, and Forest Pharmaceuticals. All other authors, no conflicts.
Jenkins et al.
Page 2
Author Manuscript
Methods—This was a secondary analysis of two published retrospective cohorts of patients requiring hospitalization for an acute bacterial skin infection between January 1, 2007 and May 31, 2012 in 7 academic and community hospitals in Colorado. In the subgroup of patients with a cutaneous abscess, microbiological findings and the antibiotic regimen started in the emergency department were compared among injection drug users and non-injection drug users. Antibiotic regimens involving multiple agents, lack of activity against MRSA, or an agent with broad gramnegative activity were classified as discordant with Infectious Diseases Society of America (IDSA) guideline treatment recommendations.
Author Manuscript
Results—Of 323 patients with a cutaneous abscess, 104 (32%) occurred in injection drug users. Among the 235 cases where at least one microorganism was identified by culture, S. aureus was identified less commonly among injection drug users compared with non-injection drug users (55% vs 75%, p = .003), with similar patterns observed for both MRSA (33% vs. 47%, p = .054) and methicillin-susceptible S. aureus (17% vs. 26%, p = .11). In contrast to S. aureus, streptococcal species (53% vs 25%, p
Acad Emerg Med. Author manuscript; available in PMC 2016 August 01. Published in final edited form as: Acad Emerg Med. 2015 August ; 22(8): 993–997. doi:10.1111/acem.12727.
Microbiology and Initial Antibiotic Therapy for Injection Drug Users and Non-Injection Drug Users with Cutaneous Abscesses in the Era of Community-Associated Methicillin-Resistant Staphylococcus aureus
Author Manuscript
Timothy C. Jenkins, MD1,2,5,6, Bryan C. Knepper, MPH, MSc3, S. Jason Moore, PhD, PA7, Carla C. Saveli, MD5,6, Sean W. Pawlowski, MD8, Daniel M. Perlman, MD, MBA9, Bruce D. McCollister, MD5,6,10,11, and William J. Burman, MD1,2,4,5,6 1Department 2Division
of Infectious Diseases, Denver Health, Denver, Colorado
3Department 4Denver
of Medicine, Denver Health, Denver, Colorado
of Patient Safety and Quality, Denver Health, Denver, Colorado
Public Health, Denver Health, Denver, Colorado
5Department 6Division
of Medicine, University of Colorado School of Medicine, Aurora, Colorado
of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado
7Department
Author Manuscript
8Colorado
of Trauma and Critical Care Services, Vail Valley Medical Center, Vail, Colorado
Infectious Disease Associates, Denver, Colorado
9Department
of Medicine, Porter Adventist Medical Center, Denver, Colorado
10Department 11Division
of Medicine, Denver Veterans Affairs Medical Center, Denver, Colorado
of Infectious Diseases, Denver Veterans Affairs Medical Center, Denver, Colorado
Abstract
Author Manuscript
Objectives—The incidence of cutaneous abscesses has increased markedly since the emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Injection drug use is a risk factor for abscesses and may impact the microbiology and treatment of these infections. In a cohort of patients hospitalized with cutaneous abscesses in the era of CA-MRSA, our objectives were to: 1) compare the microbiology of abscesses between injection drug users and non-injection drug users, and 2) evaluate antibiotic therapy started in the emergency department in relation to microbiological findings and national guideline treatment recommendations.
Corresponding author: Timothy C. Jenkins, MD, 660 Bannock Street, Denver, Colorado 80204, Office: 303-602-5041, Fax: 303-602-5055, [email protected]. Prior presentations: This work was presented in part at ID Week 2014, October 8 – 12th, Philadelphia, PA Disclosures Potential conflicts of interest: TCJ: Durata Therapeutics. DMP: Optimer, Cubist, and Forest Pharmaceuticals. All other authors, no conflicts.
Jenkins et al.
Page 2
Author Manuscript
Methods—This was a secondary analysis of two published retrospective cohorts of patients requiring hospitalization for an acute bacterial skin infection between January 1, 2007 and May 31, 2012 in 7 academic and community hospitals in Colorado. In the subgroup of patients with a cutaneous abscess, microbiological findings and the antibiotic regimen started in the emergency department were compared among injection drug users and non-injection drug users. Antibiotic regimens involving multiple agents, lack of activity against MRSA, or an agent with broad gramnegative activity were classified as discordant with Infectious Diseases Society of America (IDSA) guideline treatment recommendations.
Author Manuscript
Results—Of 323 patients with a cutaneous abscess, 104 (32%) occurred in injection drug users. Among the 235 cases where at least one microorganism was identified by culture, S. aureus was identified less commonly among injection drug users compared with non-injection drug users (55% vs 75%, p = .003), with similar patterns observed for both MRSA (33% vs. 47%, p = .054) and methicillin-susceptible S. aureus (17% vs. 26%, p = .11). In contrast to S. aureus, streptococcal species (53% vs 25%, p
