We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Antibacterials as Adjuncts to Incision and Drainage for Adults with Purulent Methicillin-Resistant Staphylococcus aureus (MRSA) Skin Infections.
- Authors
Forcade, Nicolas A.; Wiederhold, Nathan P.; Ryan, Laurajo; Talber, Robert L.; Frei, Christopher R.
- Abstract
The annual incidence of skin and soft tissue infections (SSTIs) has nearly tripled in the US since the early 1990s. Many purulent SSTIs in the community setting are caused by methicillin-resistant Staphylococcus aureus (MRSA). Inci-sion and drainage (l&D) are indicated for most purulent MRSA infections; however, the use of adjunctive antibacterials is controversial. The objective of this study was to systematically evaluate studies that have investigated whether or not antibacterials provide added benefit to l&D alone for purulent MRSA SSTIs. We included articles from MEDLINE and The Cochrane Library that fulfilled the following criteria: (i) original research; (ii) English language; (iii) compared l&D alone versus l&D plus antibacterials for purulent MRSA SSTIs; and (iv) compared patient outcomes. We also reviewed the references of these articles to identify other relevant studies. Studies that solely exam-ined paediatric patients were excluded. To facilitate cross-study comparison, we systematically evaluated the following study characteristics: (i) study design; (ii) patient population; (iii) comparator groups; (iv) sample size; (v) outcome measures; (vi) outcome definitions; (vii) duration of follow-up; and (viii) mea-surement and adjustment of potential confounding variables. Eleven studies, spanning more than 30 years, met inclusion criteria. Two of these were conducted prior to the emergence of MRSA in the community; another evaluated cephalexin versus placebo for MRSA. None of these found added benefit of adjunctive antibacterials. Four studies compared health outcomes between patients who received 'active' or 'appropriate' therapy and those who received 'inactive' or 'inappropriate' therapy after I&D for purulent MRSA SSTIs. Two of these studies found 'active' or 'appropriate' therapy to be beneficial, while two others did not. Four studies compared health outcomes between patients who received anti-MRSA antibacterials plus I&D with those who received alternative antibacterials plus I&D for purulent MRSA SSTIs. Three of these reported improved outcomes with anti-MRSA antibacterials, while another reported mixed findings. Presently, the bulk of the available evidence suggests anti-MRSA anti-bacterials provide added benefit to I&D alone for purulent MRSA SSTIs; however, the current evidence is limited to small, case-control, observational studies.
- Subjects
ANTIBIOTICS; COMBINED modality therapy; DATABASES; INFECTION; INFORMATION storage &; retrieval systems; MEDICAL databases; MEDLINE; META-analysis; SKIN; WOUND infections; METHICILLIN-resistant staphylococcus aureus
- Publication
Drugs, 2012, Vol 72, Issue 3, p339
- ISSN
0012-6667
- Publication type
Journal Article
- DOI
10.2165/11599510-000000000-00000