ArticleOpen forum infectious diseases2018
Guidelines vs Actual Management of Skin and Soft Tissue Infections in the Emergency Department.
Article in Open forum infectious diseases, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 40 citations in OpenAlex.
- Improving Empiric Antibiotic Selection for Patients Hospitalized With Skin and Soft Tissue Infection: The INSPIRE 3 Skin and Soft Tissue Randomized Clinical Trial.JAMA internal medicine · 2025Trial
- Operationalizing Single-Dose Long-Acting Lipoglycopeptides for Treatment of ABSSSI in a U.S. Community Hospital Emergency Department.Clinical drug investigation · 2026Article
- Low-Value Blood Culture Use in Adult Emergency Department Patients: A Scoping Review.Emergency medicine Australasia : EMA · 2026Article
- Empiric outpatient antibiotic prescribing patterns in the emergency department.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- A Quality Improvement Initiative to Decrease Hospital Admission for Skin and Soft Tissue Infections From an Observation Unit.Journal of the American College of Emergency Physicians open · 2025Article
- Utility of Routine Blood Cultures for Upper Extremity Abscesses.Hand (New York, N.Y.) · 2025Article
- Current approach to skin and soft tissue infections. Thinking about continuity of care.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2023Review
- Antimicrobial Management of Skin and Soft Tissue Infections among Surgical Wards in South Africa: Findings and Implications.Antibiotics (Basel, Switzerland) · 2023Article
- Article
- Characterizing barriers to antibiotic stewardship for skin and soft-tissue infections in the emergency department using a systems engineering framework.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2022Article
- It's about the patients: Practical antibiotic stewardship in outpatient settings in the United States.Frontiers in medicine · 2022Review
- Variation by Race in Antibiotics Prescribed for Hospitalized Patients With Skin and Soft Tissue Infections.JAMA network open · 2021Article
- Current and future options for treating complicated skin and soft tissue infections: focus on fluoroquinolones and long-acting lipoglycopeptide antibiotics.The Journal of antimicrobial chemotherapy · 2021Article
- International survey evaluating treatment of primary superficial skin abscesses.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2021Article
- Real-World Evidence Studies of Oritavancin Use in Gram-Positive Infections Augment Randomized Controlled Trials to Address Clinical and Economic Outcomes.Drugs - real world outcomes · 2020Article
- A Multicenter Evaluation of Vancomycin-Associated Acute Kidney Injury in Hospitalized Patients with Acute Bacterial Skin and Skin Structure Infections.Infectious diseases and therapy · 2020Article
- Multicenter Study of the Real-World Use of Ceftaroline versus Vancomycin for Acute Bacterial Skin and Skin Structure Infections.Antimicrobial agents and chemotherapy · 2019Article
- Adherence to antibiotic guidelines for erysipelas or cellulitis is associated with a favorable outcome.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2019Article
- Variability in Emergency Medicine Provider Decisions on Hospital Admission and Antibiotic Treatment in a Survey Study for Acute Bacterial Skin and Skin Structure Infections: Opportunities for Antimicrobial Stewardship Education.Open forum infectious diseases · 2018Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundInfections of skin and soft tissue (SSTI) commonly cause visits to hospital emergency departments (EDs). The Infectious Diseases Society of America (IDSA) has published guidelines for the management of SSTI, but it is unclear how closely these guidelines are followed in practice.
methodsWe reviewed records of patients seen in the ED at a large tertiary care hospital to determine guidelines adherence in 4 important areas: the decision to hospitalize, choice of antibiotics, incision and drainage (I&D) of abscesses, and submission of specimens for culture.
resultsThe decision to hospitalize did not comply with guidelines in 19.6% of cases. Nonrecommended antibiotics were begun in the ED in 71% of patients with nonpurulent infections and 68.4% of patients with purulent infections. Abscesses of mild severity were almost always treated with antibiotics, and I&D was often not done (both against recommendations). Blood cultures were done (against recommendations) in 29% of patients with mild-severity cellulitis. Abscess drainage was almost always sent for culture (recommendations neither favor nor oppose). Overall, treatment fully complied with guidelines in 20.1% of cases.
conclusionsOur results show a striking lack of concordance with IDSA guidelines in the ED management of SSTI. Social factors may account for discordant decisions regarding site of care. Use of trimethoprim/sulfamethoxazole (TMP/SMX) in cellulitis was the most common source of discordance; this practice is supported by some medical literature. Excess antibiotics were often used in cellulitis and after I&D of simple abscesses, opposing antibiotic stewardship. Ongoing education of ED doctors and continued review of published guidelines are needed.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.