Inappropriate antibiotic use in soft tissue infections

Arch Surg. 2006 Sep;141(9):850-4; discussion 855-6. 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.

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Chi-Square Distribution
  • Combined Modality Therapy
  • Drainage
  • Female
  • Humans
  • Male
  • Methicillin Resistance
  • Microbial Sensitivity Tests
  • Middle Aged
  • Retrospective Studies
  • Soft Tissue Infections / drug therapy*
  • Soft Tissue Infections / etiology
  • Soft Tissue Infections / surgery*
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / etiology
  • Staphylococcal Infections / surgery
  • Substance Abuse, Intravenous / complications
  • Treatment Outcome


  • Anti-Bacterial Agents