Daniel J. Pallin, MD, MPH reviewing Haran JP et al. Am J Emerg Med 2016 Oct 28.

In a retrospective study, patients aged >65 years had nearly four times the odds of treatment failure as younger patients.

A recent large randomized trial showed that antibiotics are beneficial in the treatment of cutaneous abscesses, contradicting prior findings from multiple small studies (NEJM JW Emerg Med Apr 2016 and N Engl J Med 2016; 374:823). However, the benefit of antibiotics was modest, prompting the question of whether some patient subsets might benefit more than others.

To determine whether older patients are more likely to fail therapy, investigators retrospectively reviewed charts for 572 adult patients treated for abscess and discharged from one of four emergency departments (EDs). Follow-up data were available for 467 patients (82%), of whom 35 were aged 65 or older. Overall, 23% of patients did not undergo incision and drainage during the index visit. The authors note that patients older than 65 were similar to younger patients with regard to infection location, whether they received incision and drainage, and whether they were given antibiotics in the ED or at home. Multivariable logistic regression revealed that every decade of advancing age conferred 43% higher odds of treatment failure, defined as need for a change in antibiotics, surgical intervention, or hospitalization by 1 month.

CITATION(S):

Haran JP et al. Elderly patients are at increased risk for treatment failure in outpatient management of purulent skin infections. Am J Emerg Med 2016 Oct 28; [e-pub]. 

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