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Abstract:
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Our investigation sought to identify the incidence of treatment failure and its associated costs in patients with methicillin -resistant Staphylococcus aureus (MRSA ) skin and soft tissue infections (SSTIs ) treated in the primary care setting . Thirteen clinics participated in this multi -site , observational study . Clinicians consented patients and collected clinical information , pictures , and wound swabs ; isolates were processed in the principal investigator's laboratory . Treatment failure was defined as the occurrence of one or more of the following within 90 days : (1 ) change in antibiotic therapy , (2 ) subsequent need for incision and drainage , (3 ) SSTI at new site , (4 ) SSTI at same site , (5 ) emergency department visit , or (6 ) hospitalization . Cost estimates were obtained from the Agency for Healthcare Research and Quality (AHRQ ) and Centers for Medicare and Medicaid Service's National Average Drug Acquisition Costs (NADAC ) . Patients were considered to have “moderate or complicated” SSTIs if they had a lesion ≥ 5cm in diameter , diabetes mellitus , or both . Patients not exhibiting these characteristics were classified as having “mild or uncomplicated” infections . Ninety -eight patients were enrolled . Most patients were of Hispanic ethnicity and more than half of all patients had a body mass index (BMI ) ≥ 30kg /m2 . The most common treatment modality was incision and drainage (I &D ) plus antibiotics (57 % ) . Treatment failure occurred in 21 % of all patients at a mean additional cost of $1 ,933 .71 . Patients with moderate or complicated SSTIs who received I &D experienced significantly more treatment failures compared mild or uncomplicated patients who received I &D (36 % vs . 10 % ; p = 0 .04 ) . The additional cost of treatment failure in patients with moderate or complicated SSTIs was nearly twice that of patients with mild or uncomplicated SSTIs ( $2 ,093 .40 vs . $1 ,255 .02 ; p = 1 .0 ) . Treatment failure occurred sooner , on average , in the moderate or complicated group compared to the mild or uncomplicated group (11 .8 days vs . 38 .8 days ; p = 0 .06 ) . Among patients with MRSA SSTIs treated in the primary care setting , the rate of treatment failure is high (21 % ) and costs are considerable ( $1 ,933 .71 ) . |