A Randomized Clinical Trial Comparing Use of Rapid Molecular Testing for Staphylococcus aureus for Patients With Cutaneous Abscesses in the Emergency Department With Standard of Care

Abstract

Objective: To determine whether real-time availability of rapid molecular results of Staphylococcus aureus would impact emergency department clinician antimicrobial selection for adults with cutaneous abscesses.

Design: We performed a prospective, randomized controlled trial comparing a rapid molecular test with standard of care culture-based testing. Follow-up telephone calls were made at between 2 and 7 days, 1 month, and 3 months after discharge.

Setting: Two urban, academic emergency departments.

Patients: Patients at least 18 years old presenting with a chief complaint of abscess, cellulitis, or insect bite and receiving incision and drainage were eligible. Seven hundred seventy-eight people were assessed for eligibility and 252 met eligibility criteria.

Methods: Clinician antibiotic selection and clinical outcomes were evaluated. An ad hoc outcome of test performance was performed.

Results: We enrolled 252 patients and 126 were randomized to receive the rapid test. Methicillin-susceptible S. aureus-positive patients receiving rapid test results were prescribed beta-lactams more often than controls (absolute difference, 14.5% [95% CI, 1.1%-30.1%]) whereas methicillin-resistant S. aureus-positive patients receiving rapid test results were more often prescribed anti-methicillin-resistant S. aureus antibiotics (absolute difference, 21.5% [95% CI, 10.1%-33.0%]). There were no significant differences between the 2 groups in 1-week or 3-month clinical outcomes.

Conclusion: Availability of rapid molecular test results after incision and drainage was associated with more-targeted antibiotic selection. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01523899.

Conflict of interest statement

Potential conflicts of interest. L.S.M. reports that she has received honoraria for consulting and educational presentation for Cepheid; travel and meeting expenses for Cepheid; and advisory board honorarium and travel expenses from Durata. L.G.M. reports that he has received consulting fees from Cubist, Durata, and Pfizer. R.E.R. reports that he has a Cooperative Agreement with BARDA, HHS (Influenza Diagnostic Study); a grant with Cepheid (sexually transmitted disease diagnosis); and meeting expenses for unpaid consultation by Cepheid. J.A.J. reports that she has received clinical trial funding for HIV qualitative, HIV quantitative, Trichomonas vaginalis (TV), all on GeneXpert by Cepheid. All other authors report no conflicts of interest relevant to this article.

Figures

FIGURE 1

Study Flow Diagram