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Title: A prescription for resistance: Management of staphylococcal skin abscesses by general practitioners in Australia
Austin Authors: Parrott, Christine;Wood, Gillian;Bogatyreva, Ekaterina;Coombs, Geoffrey W;Johnson, Paul D R ;Bennett, Catherine M
Affiliation: Austin Health, Heidelberg, Victoria, Australia
Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
Young People’s Health Service, Department of Adolescent Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia
Department of Microbiology, Dorevitch Pathology, Heidelberg, Victoria, Australia
School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
PathWest Laboratory Medicine – Fiona Stanley Hospital, Murdoch, Western Australia, Australia
Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 6-Jun-2016 2016-06-06
Publication information: Frontiers in Microbiology 2016; 7: 802
Abstract: OBJECTIVES: We investigated the management of staphylococcal abscesses (boils) by general practitioners (GPs) in the context of rising antibiotic resistance in community strains of Staphylococcus aureus. DESIGN, SETTING, PARTICIPANTS: We analyzed patient-reported management of 66 cases of uncomplicated skin abscesses from the frequency matched methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) Community-Onset Staphylococcus aureus Household Cohort (COSAHC) study (Melbourne, Australia, 2008-2012). Susceptibilities in all cases were known: 50/66 abscesses were caused by MRSA. In order to investigate GP-reported management of staphylococcal abscesses, we surveyed a random subset of GPs, from the COSAHC study (41), and of GPs (39) who used the same community-based pathology service (December 2011-May 2012). MAIN OUTCOME MEASURES: Patient outcomes, antibiotics prescribed, antibiotic resistance profiles of infecting strains, rates of incision and drainage (I&D), and attitudes to ordering microbiological cultures. RESULTS: MRSA was three times more likely to be cultured from an abscess than MSSA. Patient-reported management revealed 100% were prescribed antibiotics and only 60.6% had I&D. Of those 85% who remembered their prescription(s), 81% of MRSA cases and 23% of MSSA cases initially received inactive antibiotics. Repeat GP visits where antibiotics were changed occurred in 45 MRSA and 7 MSSA cases, although at least 33% of subsequent prescriptions were inactive for the MRSA infections. Patients treated with I&D and antibiotics did no better than those treated with only I&D, regardless of the antibiotic activity. In the GP surveys, 89% reported I&D, with or without antibiotics, to be their preferred management. Only 29.9% of GPs would routinely swab abscesses. CONCLUSION: The recommended management of uncomplicated Staphylococcus abscesses is I&D without antibiotics to reduce exposure to unnecessary antibiotics. In our study, I&D was performed in only 60.6% of 66 patients, and antibiotics were always prescribed. The prescribed antibiotics were frequently inactive and often changed, and did not appear to affect patient recovery. Our results show that community GPs can confidently reduce their use of antibiotics for patients with skin abscesses and should be aware that MRSA is a much more common in this type of infection.
DOI: 10.3389/fmicb.2016.00802
PubMed URL:
Type: Journal Article
Subjects: Staphylococcus aureus
Antibiotic resistance
Boils and abscesses
Community medicine
Skin and soft tissue infections
Appears in Collections:Journal articles

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