RESUMO
The Infectious Disease Society of America (IDSA) publishes guidelines regularly for the management of skin and soft tissue infections; however, the extent to which practice patterns follow these guidelines and if this can affect treatment failure rates is unknown. We observed the treatment failure rates from a multicentre retrospective ambulatory cohort of adult emergency department patients treated for a non-purulent skin infection. We used multivariable logistic regression to examine the role of IDSA classification and whether adherence to IDSA guidelines reduced treatment failure. A total of 759 ambulatory patients were included in the cohort with 17.4% failing treatment. Among all patients, 56.0% had received treatments matched to the IDSA guidelines with 29.1% over-treated, and 14.9% under-treated based on the guidelines. After adjustment for age, gender, infection location and medical comorbidities, patients with a moderate infection type had three times increased risk of treatment failure (adjusted risk ratio (aRR) 2.98; 95% confidence interval (CI) 1.15-7.74) and two times increased risk with a severe infection type (aRR 2.27; 95% CI 1.25-4.13) compared with mild infection types. Patients who were under-treated based on IDSA guidelines were over two times more likely to fail treatment (aRR 2.65; 95% CI 1.16-6.05) while over-treatment was not associated with treatment failure. Patients ⩾70 years of age had a 56% increased risk of treatment failure (aRR 1.56; 95% CI 1.04-2.33) compared with those <70 years. Following the IDSA guidelines for non-purulent SSTIs may reduce the treatment failure rates; however, older adults still carry an increased risk of treatment failure.
RESUMO
Four groups of latently infected rabbits were induced to shed HSV-1 into the tear film by a one-time ocular iontophoresis of 6-hydroxydopamine (6-HD) followed 3 days later by five consecutive days of twice daily topical epinephrine (Epi). Groups 1 and 4 had both eyes inoculated and Groups 2 and 3 had only one eye inoculated. Groups 1 and 2 had eyes swabbed to detect HSV-1, and Groups 3 and 4 had eyes washed. Group 1 was iontophoresed with 1.0% 6-HD at 0.5 mAmp for 5 min, and Groups 2, 3 and 4 were iontophoresed with 0.1% 6-HD at 0.75 mAmp for 5 min. Group 1 received topical 2.0% Epi, and Groups 2, 3, and 4 received topical 1.0% Epi. Inoculated eyes in all groups shed HSV-1 during the induction period. The peak of HSV-1 shedding occurred on the last day of Epi application for Groups 1 and 2, and on the day after the last Epi application for Groups 3 and 4. The ratio of total positive tear film samples to total samples for inoculated eyes that received 6-HD and Epi were 53/119 (45%), 38/87 (44%), 24/66 (36%), and 14/33 (42%) for Groups 1, 2, 3, and 4, respectively. Therefore, even reduced concentrations of 6-HD and Epi, as well as beginning Epi 3 days after 6-HD, induced HSV-1 ocular shedding.