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Rapid molecular testing for S. aureus optimizes ED antibiotic selection
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The use of rapid molecular testing for Staphylococcus aureus, including identification of methicillin resistance, may help to optimize antibiotic treatment regimens among ED patients presenting with cutaneous abscesses, according to results from a prospective, randomized controlled trial.
Loren G. Miller, MD, MPH, an investigator at the Los Angeles Biomedical Research Institute, and colleagues evaluated 252 patients who were treated at the George Washington and Johns Hopkins EDs from April 2011 to April 2014. Eligible participants were aged 18 years or older, had a primary presentation of abscess, cellulitis or insect bite, and underwent treatment with incision and drainage. Patients were randomly allocated to the test group (n = 126) or control group (n = 126). Patients in the test group had wound samples analyzed through culture and rapid molecular testing, while control group samples were tested through culture only.
Loren G. Miller
The study’s primary outcome was antibiotic selection (anti-MRSA, beta-lactam or none) between groups. The researchers also monitored clinical outcomes after hospital discharge through telephone calls made between 2 to 7 days, at 1 month and at 3 months.
The researchers found that beta-lactams were more frequently prescribed to methicillin-susceptible S. aureus (MSSA)-positive patients who underwent rapid molecular testing compared with MSSA patients in the control group (absolute difference, 14.5%; 95% CI, 1.1%-30.1%). Meanwhile, anti-MRSA antibiotics were more frequently prescribed to MRSA-positive patients in the test group than to MRSA-positive controls (absolute difference, 21.5%; 95% CI, 10.1%-33%). No significant differences in clinical outcomes were observed at 1-week or 3-month follow-ups.
Miller and colleagues said these findings support the potential utility of rapid molecular testing for S. aureus in an ED setting.
“Our investigation found that rapid diagnostic testing for S. aureus, including detection of methicillin resistance, in ED patients with cutaneous abscesses improved antibiotic stewardship,” they wrote. “Consideration should be made to developing protocols that incorporate this type of real-time testing to facilitate patient evaluation and management of ED patients with cutaneous abscesses.” – by Jen Byrne
Disclosures: May reports receiving travel and meeting expenses and honoraria from consulting and educational presentation for Cepheid, and advisory board honorarium and travel expenses from Durata. Miller reports receiving consulting fees from Cubist, Durata and Pfizer. Please see the full study for a list of all other authors’ relevant financial disclosures.
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