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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

Published online by Cambridge University Press:  26 August 2015

Larissa S. May ,
Richard E. Rothman ,
Loren G. Miller ,
Gillian Brooks ,
Mark Zocchi ,
Catherine Zatorski ,
Andrea F. Dugas ,
Chelsea E. Ware  and
Jeanne A. Jordan
Larissa S. May*
Affiliation:
Emergency Department Antibiotic Stewardship, Department of Emergency Medicine, University of California–Davis, Sacramento, California
Richard E. Rothman
Affiliation:
Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland
Loren G. Miller
Affiliation:
Los Angeles BioMedical Research Center at Harbor-UCLA Medical Center, Torrance, California
Gillian Brooks
Affiliation:
Department of Emergency Medicine, George Washington University, Washington, DC
Mark Zocchi
Affiliation:
Office for Clinical Practice Innovation, George Washington University, Washington, DC
Catherine Zatorski
Affiliation:
Department of Emergency Medicine, George Washington University, Washington, DC
Andrea F. Dugas
Affiliation:
Los Angeles BioMedical Research Center at Harbor-UCLA Medical Center, Torrance, California
Chelsea E. Ware
Affiliation:
Department of Emergency Medicine, George Washington University, Washington, DC
Jeanne A. Jordan
Affiliation:
Department of Epidemiology and Biostatistics, School of Public Health, George Washington University, Washington, DC
*
Address correspondence to Larissa S. May, MD, University of California–Davis, Department of Emergency Medicine, 4150 V St, Ste 2100, Sacramento, CA 95817 (larissa.may@gmail.com).
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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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 12 , December 2015 , pp. 1423 - 1430
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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