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Published on: February 9, 2011
Skin and Soft Tissue Infection Treatment and Prevention Practices by Pediatric Emergency Medicine Providers
Rakesh D Mistry1, Patrick G Hogan2, Katelyn L Parrish2
1From the Department of Pediatrics-Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
Insights
Pediatric emergency clinicians often prescribe oral antibiotics for skin and soft tissue infections (SSTIs) but do not consistently follow evidence-based guidelines for adjuvant antibiotics or decolonization. Developing institutional guidelines can improve care.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Clinical Practice Guidelines
Background:
- Skin and soft tissue infections (SSTIs) are common in pediatric emergency departments.
- Current evidence supports adjuvant antibiotics and decolonization strategies for SSTI management.
- Adherence to these evidence-based practices among clinicians is not well understood.
Purpose of the Study:
- To evaluate the treatment and prevention practices for SSTIs among pediatric emergency medicine (PEM) clinicians.
- To assess adherence to current clinical practice guidelines and contemporary evidence in SSTI management.
- To identify gaps in current practices and inform the development of institutional guidelines.
Main Methods:
- A cross-sectional survey was conducted among PEM clinicians from the American Academy of Pediatrics Section on Emergency Medicine Survey listserv.
- Respondents were presented with four hypothetical pediatric SSTI clinical scenarios.
- Survey items assessed treatment and prevention practices, including antibiotic choice, duration, and preventive measures, along with provider demographics.
Main Results:
- Over half of the 160 respondents indicated prescribing oral antibiotics for all scenarios, with higher rates for complex cases (e.g., febrile abscess, 90.3%).
- Clindamycin and trimethoprim-sulfamethoxazole were the most frequently prescribed antibiotics, with over 80% selecting a treatment duration of 7 days or more.
- While most clinicians recommended hygiene measures (85.1%), fewer prescribed decolonization (52.5% topical antibiotic, 77.5% antiseptic washes).
- Only half of the respondents reported their institution having standard SSTI management guidance.
Conclusions:
- PEM clinicians' current practices for SSTI treatment and prevention do not consistently align with evidence supporting adjuvant antibiotics and decolonization.
- There is a need for the development and implementation of institutional guidelines to support evidence-based decision-making at the point of care.
- Improving adherence to guidelines can enhance the management of pediatric SSTIs.
Objective:
The aim of the study was to evaluate skin and soft tissue infection (SSTI) treatment and prevention practices among pediatric emergency medicine (PEM) clinicians in the context of current clinical practice guidelines and contemporary evidence.
Methods:
This was a cross-sectional survey of PEM clinicians belonging to the American Academy of Pediatrics Section on Emergency Medicine Survey listserv. Four varying hypothetical clinical scenarios of children with SSTI were posed to respondents; subsequent items assessed SSTI treatment and prevention practices. Provider demographics were collected.
Results:
Of 160 survey respondents, more than half stated that they would prescribe oral antibiotics for each clinical scenario, particularly for more complex presentations (small uncomplicated abscess, 51.8%; large uncomplicated abscess, 71.5%; recurrent abscess, 83.5%; febrile abscess, 90.3%; P < 0.001). Most commonly selected antibiotics were clindamycin and trimethoprim-sulfamethoxazole. Across scenarios, more than 80% selected a duration of treatment 7 days or more. Of the 121 respondents who prescribe preventive measures, 85.1% recommend hygiene measures; 52.5% would prescribe decolonization with topical antibiotic ointment and 77.5% would recommend antiseptic body washes. Half of the respondents reported that their institution has standard guidance for SSTI management.
Conclusions:
Although current evidence supports adjuvant antibiotics for all drained SSTI and decolonization for the index patient and household contacts, PEM clinicians do not consistently adhere to these recommendations. In light of these findings, development and implementation of institutional guidelines are necessary to aid PEM clinicians' point-of-care decision making and improving evidence-based practice.
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