Community-Assoc. S. Aureus Colonization and Recurrent Infection in Pts With Uncomplicated S. Aureus Skin Abscesses
Condition: MRSA
MeSH terms: Reinfection
Study type: Observational

Summary: 
      Infections due to S. aureus are a major healthcare burden. Currently there is not an
      effective way to prevent S. aureus infection. Treatment failure can happen in up to 20% of
      patients with SSTI and mean additional cost per patient can be over $1500. Antibiotics are
      often prescribed for the treatment of CA-S. aureus SSTI. Current IDSA CA-MRSA guidelines
      suggest that incision and drainage alone may be adequate for management of uncomplicated
      CA-S. aureus skin abscesses and there is uncertainty about the need of antibiotics. It is not
      known whether antibiotics are helpful in decreasing S. aureus colonization rates or
      preventing future S. aureus infections. Though resolution of acute abscess after drainage may
      be unchanged by antibiotic administration, the impact of managing S. aureus abscess without
      antibiotics on ongoing S. aureus colonization and recurrent infection requires further study.
      This study seeks to examine whether the management of initial S. aureus abscesses with
      incision and drainage in addition to antibiotic therapy is an effective means of preventing
      recurrent infection. The prolonged longitudinal follow-up of this study is another unique
      characteristic that will enable the investigators to capture data about recurrences of
      infections.
    

Detailed description: 
      Methicillin-resistant Staphylococcus aureus (MRSA) was once associated almost exclusively
      with healthcare-associated infections. However, new epidemic strains have emerged outside of
      the healthcare environment designated community-associated (CA) MRSA. From 1999 to 2005,
      hospitalizations for Staphylococcus aureus-related skin and soft tissue infections (SSTI) in
      the United States increased 4-fold to nearly 90,000 annually. At Memorial Medical Center
      (MMC) Emergency Department (ED) and Express Cares (EC) there have been over 6500 visits in
      the last 6 years secondary to SSTI.

      Current Infectious Diseases Society of America (IDSA) guidelines suggest incision and
      drainage alone (without antibiotics) may be adequate management for uncomplicated MRSA skin
      abscesses. However, patients not receiving antibiotics are more likely to develop recurrent
      infections, which may be a result of persistent MRSA colonization. The investigators will
      conduct a prospective case-control study at MMC ED, EC and MMC primary care clinics of
      pediatric patients with skin abscesses comparing outcomes for those who received antibiotics
      (cases) versus those who did not (controls). This will not be an intervention study - both
      surgical and medical management of patients with skin abscesses will be at the discretion of
      the treating physician.

      The central hypothesis is that the inclusion of systemic antibiotics in the management of S.
      aureus skin abscesses will decrease S. aureus colonization, and subsequently the incidence of
      recurrent SSTI in the year following baseline infection. To gain a better understanding of
      this problem, the investigators propose the following specific aims:
    

Intervention name(s): Antibiotics Given; Antibiotics not given
Intervention type(s): Procedure; Procedure
Intervention description(s): Patients who's treating physician prescribed antibiotics; Patients who's treating physician did not prescribed antibiotics
Intervention MeSH terms: Anti-Bacterial Agents; Antibiotics, Antitubercular
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Pediatric patients presenting in the Emergency Department or Express Cares and Primary Care
        Clinics with skin abscesses who do and do not receive antibiotic therapy at two time
        points.
      
Biospecimen description: 
      colonization swabs from the nose, axilla, inguinal folds and wound isolate