Non-Purulent Skin and Soft Tissue Infections in the Emergency Department

Abstract

Non-purulent skin and soft tissue infections (SSTIs) involve the epidermis and dermis and are commonly managed in the emergency department (ED). Current guidelines lack evidence to guide clinicians on optimal management. The aim of this thesis was to describe the epidemiology of adults with non-purulent SSTIs presenting to the ED. Secondary goals were to identify factors associated with oral antibiotic treatment failure; describe an outpatient parenteral antibiotic therapy (OPAT) clinic-to-ED program; and determine physician rationale for selecting intravenous therapy. We conducted a health records review and prospective observational cohort study. There was significant physician practice variation and an unexpectedly high hospitalization rate. We identified four factors associated with oral antibiotic treatment failure (tachypnea, chronic ulcers, history of methicillin resistant Staphylococcus aureus colonization or infection, and cellulitis in the past 12 months). An ED-to-OPAT clinic program was found to be safe, with low treatment failure rates and high patient satisfaction.