Antimicrobial Stewardship Through MRSA Diagnosis in Emergency Department (ED) Patients With Abscesses

George Washington University (GW)

Status: Completed

Conditions: Cutaneous Abscess

Treatments: Diagnostic Test: Standard culture; Device: Xpert MRSA/SA SSTI

Study type: Interventional

Funder types: Other

Identifiers

NCT01523899

030927

Details and patient eligibility

About

This study expands upon pilot data for feasibility since May 2011. The study aims to evaluate the effect of rapid test availability on use of targeted spectrum antibiotics for non-MRSA abscesses in ambulatory patients in the Emergency Department (ED). The multi-institutional study will assess the feasibility of providing the GeneXpert® MRSA/SA SSTI assay to the ED and evaluate the impact of delivering the test result to clinicians in real-time on patient management decisions regarding the use of antimicrobial agents. Patients are randomized to standard culture (control arm) or to the GeneXpert® assay plus standard culture.

Full description

Our objective was 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.

We performed a prospective, randomized controlled trial in two urban emergency departments 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.

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.

Enrollment: 252 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• adults 18 years or older with community onset abscess

Exclusion criteria

• previous treatment for same abscess in past 14 days
• postoperative infection
• inability to provide informed consent

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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252 participants in 2 patient groups

Xpert MRSA/SA SSTI

Experimental group

Description:

use of the Xpert MRSA/SSTI diagnostic assay

Treatment:

Device: Xpert MRSA/SA SSTI

Standard culture

Active Comparator group

Description:

performance of standard bacterial culture of abscess material

Treatment:

Diagnostic Test: Standard culture