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September 1, 2006

Inappropriate Antibiotic Use in Soft Tissue Infections

Author Affiliations

Author Affiliations: Department of Surgery (Drs Paydar, Hansen, Harris, and Young) and Division of Infectious Diseases, Department of Medicine, Epidemiology and Prevention Interventions Center (Dr Charlebois), San Francisco General Hospital, University of California, San Francisco.

Arch Surg. 2006;141(9):850-856. doi:10.1001/archsurg.141.9.850

Hypothesis  Many soft tissue infections treated with surgical drainage resolve even when treated with antibiotics not active against the organism isolated from the infection.

Design  Retrospective.

Setting  Integrated Soft Tissue Infection Services clinic.

Patients  All patients treated from July 19, 2000, to August 1, 2001, who underwent surgical drainage of a soft tissue infection and had microbiological culture results.

Main Outcome Measures  Documented resolution of the infection with drainage of the abscess and antibiotic therapy alone was deemed a cure. An infection resulting in death or other surgical therapy was deemed a failure. Therapy was appropriate when the organism was sensitive to prescribed antibiotics and was inappropriate when the organism was insensitive.

Results  The study included 376 patients with 450 infections. Staphylococcus aureus as the primary organism was isolated from 441 of the cultures. Methicillin sodium–sensitive S aureus and methicillin-resistant S aureus were found in 157 and 284 of these isolates, respectively. Appropriate antibiotics were prescribed in 153 infections with methicillin-sensitive S aureus and in 25 with methicillin-resistant S aureus. Of 441 episodes, 408 were clinically evaluated for cure. Three patients failed treatment, 2 in the appropriately treated group (resulting in death and amputation) and 1 patient with osteomyelitis in the inappropriately treated group. The cure rate for infections treated appropriately or inappropriately was the same.

Conclusions  Treatment of soft tissue infections after surgical drainage, even with inappropriate antibiotics, has a high cure rate. Further studies to evaluate the efficacy of treating these infections without antibiotics are needed.