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Skin and Soft Tissue Infection Management, Outcomes, and Follow-Up in the Emergency Department of an Urban Academic Hospital

Seeleang, Kanokwan DNP, CRNP, FNP-BC; Manning, Mary Lou CRNP, PhD, CIC, FAAN; Saks, Mark MD, MPH, FAAEM; Winstead, Yvette DNP, CRNP, FNP-BC, MBA

doi: 10.1097/TME.0000000000000039
CASES OF NOTE
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Skin and soft tissue infections (SSTIs) are among the most common infections treated by emergency department clinicians. The emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) as the cause of these infections prompted the Centers for Disease Control and Prevention and the Infectious Disease Society of America to publish guidelines for the outpatient management of SSTIs. This study describes the management and outcomes of emergency department patients treated for uncomplicated SSTIs who returned within 30 days of the initial visit. The study found that of 857 eligible patients, only 17.6% returned and of these, 80% had their wound checked or packing removed. The clinicians prescribed antibiotics for the majority of patients, and the selection of antibiotics typically was active against CA-MRSA. Of 91 lesions drained, 24 specimens were obtained for culture and sensitivity. The majority of the initial treatment of patients consisted of incision and drainage with antibiotic prescription.

Emergency Department, Hahnemann University Hospital, Philadelphia, Pennsylvania (Dr Seeleang); Thomas Jefferson University, Jefferson School of Nursing, Philadelphia, Pennsylvania (Drs Seeleang, Manning, and Winstead); Department of Emergency Medicine, Crozer-Chester Medical Center, Chester, Pennsylvania (Dr Saks); Emergency Medicine Drexel University College of Medicine, Philadelphia, Pennsylvania (Dr Saks); and Aria Health, Philadelphia, Pennsylvania (Dr Winstead).

Corresponding Author: Kanokwan Seeleang, DNP, CRNP, FNP-BC, Emergency Department, Hahnemann University Hospital, 230 N Broad St, Philadelphia, PA 19102 (kanokwan.seeleang@jefferson.edu).

The authors thank Dr. Hamilton Richard, Dr. Dunn Rosemary, McCloskey Elizabeth, Silverman Mary Kay, Heather Guiliano, Linda Celia, and Nancy Vanek for their many hours of consultation and support.

Disclosure: The authors report no conflicts of interest.

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