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Observational Study
. 2018 Oct;55(4):512-521.
doi: 10.1016/j.jemermed.2018.06.036. Epub 2018 Aug 24.

Effectiveness of Outpatient Antibiotics After Surgical Drainage of Abscesses in Reducing Treatment Failure

Michael S Pulia  1 , Rebecca J Schwei  1 , Brian W Patterson  1 , Michael D Repplinger  1 , Maureen A Smith  2 , Manish N Shah  1
Affiliations
Observational Study

Effectiveness of Outpatient Antibiotics After Surgical Drainage of Abscesses in Reducing Treatment Failure

Michael S Pulia et al. J Emerg Med. 2018 Oct.

Abstract

Background: The optimal approach to outpatient antibiotic use after surgical drainage of abscesses is unclear given conflicting clinical trial results.

Objective: Our primary objective was to evaluate the real-world effectiveness of outpatient antibiotic prescribing after surgical drainage of cutaneous abscesses on reducing treatment failure.

Methods: We performed a retrospective observational study using data extracted from the electronic health record of a single academic health care system. All emergency department (ED) visits that resulted in discharge with a surgical drainage of a cutaneous abscess procedure code were included in the sample. All visits were categorized into having received or not having received an antibiotic prescription at the index visit. Outcome frequencies were compared using Pearson's chi-squared test. A multivariable logistic regression model was used to estimate the odds of treatment failure among those who did and did not receive an antibiotic prescription at their index ED visit.

Results: The final sample consisted of 421 index ED visits, of which 303 (72%) received an antibiotic prescription. Treatment with antibiotics after drainage did not significantly reduce the odds of composite treatment failure within 30 days when controlling for sociodemographic and clinical encounter variables (odds ratio 0.52, 95% confidence interval 0.23-1.21).

Conclusions: This real-world, comparative effectiveness analysis did not demonstrate any significant reduction in treatment failure with the use of antibiotics after drainage of abscesses in the ED. It is unclear if the clinical benefit observed under controlled trial conditions will carry over to routine clinical practice where varied antibiotic regimens are the norm and local bacterial resistance patterns vary.

Keywords: abscess; antibiotics; antimicrobial stewardship; emergency department; incision and drainage.

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