A living systematic review

Short URL:openmetaanalysis.github.io/ssti

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Clinical summary: This meta-analysis suggests that the clinical intervention is effective; however, meta-regression indicates that the benefit inversely correlates with the mortality rate in the control group. While benefit also correlates with year of publication, only the the mortality rate in the control group is an independent predictor. The moderate heterogeneity was explained by variations in the mortality rate in the control groups of the trials (see meta-regression below) and the heterogeneity was 'unimportant' after the rate of outcomes among controls was added to the meta-regression (residual I2 = 0%). Accordingly, the two most recent trials both had less than 20% mortality in the control group, and the intervention did not reduce mortality. The quality of evidence supporting benefit in trials with high mortality is low due to all trials being unblinded and the benefit being in a small number of subjects studied and an unplanned subgroup analysis. We included randomized controlled trials of treating patients with septic shock with early-goal directed therapy. Additional interpretations may be in the references in the 'Cited by' section below.

Methods overview: This repository is an openMetaAnalysis that combines methods of scoping, rapid, and living systematic reviews. This analysis updates one or more previously published review(s)(1).

  Newer studies included are listed in the references. Rationale for newer trials excluded may be listed at the end of the references.

A comparison of studies included in this review compared to prior reviews are in the table, reconciliation of studies included with prior meta-analyses. Studies were abstacted into standardized tables of , and results.

Results: Details of the studies included are in the:

Below is the forest plot for the primary outcome. Additional Forest plots may be available. Image of forest plot of primary outcome

The Summary of Findings Table (SoF) from the GRADE Profile is below (source files). Image of GRADE Summary of findings table

References:

Systematic review(s)

Most recent review(s) at time of last revision of this repository

  1. Fahimi J, Singh A, Frazee BW. The role of adjunctive antibiotics in the treatment of skin and soft tissue abscesses: a systematic review and meta-analysis. CJEM. 2015 Jul;17(4):420-32. doi: 10.1017/cem.2014.52. Epub 2015 Feb 20. Review. PubMed PMID: 26013989. Singer AJ, Thode HC Jr. Systemic antibiotics after incision and drainage of simple abscesses: a meta-analysis. Emerg Med J. 2014 Jul;31(7):576-578. doi: 10.1136/emermed-2013-202571. Epub 2013 May 18. Review. PubMed PMID: 23686731.

Studies

New Studies not included in the most recent review above

  1. Daum RS, Miller LG, Immergluck L, Fritz S, Creech CB, Young D, Kumar N, Downing M, Pettibone S, Hoagland R, Eells SJ, Boyle MG, Parker TC, Chambers HF; DMID 07-0051 Team. A Placebo-Controlled Trial of Antibiotics for Smaller Skin Abscesses. N Engl J Med. 2017 Jun 29;376(26):2545-2555. doi: 10.1056/NEJMoa1607033. PubMed PMID: 28657870.
  2. Talan DA, Mower WR, Krishnadasan A, Abrahamian FM, Lovecchio F, Karras DJ, Steele MT, Rothman RE, Hoagland R, Moran GJ. Trimethoprim-Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess. N Engl J Med. 2016 Mar 3;374(9):823-32. doi: 10.1056/NEJMoa1507476. PubMed PMID: 26962903; PubMed Central PMCID: PMC4851110

Older Studies possibly included in the most recent review above

  1. Chen AE, Carroll KC, Diener-West M, Ross T, Ordun J, Goldstein MA, Kulkarni G, Cantey JB, Siberry GK. Randomized controlled trial of cephalexin versus clindamycin for uncomplicated pediatric skin infections. Pediatrics. 2011 Mar;127(3):e573-80. doi: 10.1542/peds.2010-2053. Epub 2011 Feb 21. PubMed PMID: 21339275; PubMed Central PMCID: PMC3387913
  2. Schmitz GR, Bruner D, Pitotti R, Olderog C, Livengood T, Williams J, Huebner K, Lightfoot J, Ritz B, Bates C, Schmitz M, Mete M, Deye G. Randomized controlled trial of trimethoprim-sulfamethoxazole for uncomplicated skin abscesses in patients at risk for community-associated methicillin-resistant Staphylococcus aureus infection. Ann Emerg Med. 2010 Sep;56(3):283-7. doi: 10.1016/j.annemergmed.2010.03.002. Epub 2010 Mar 26. Erratum in: Ann Emerg Med. 2010 Nov;56(5):588. PubMed PMID: 20346539.
  3. Duong M, Markwell S, Peter J, Barenkamp S. Randomized, controlled trial of antibiotics in the management of community-acquired skin abscesses in the pediatric patient. Ann Emerg Med. 2010 May;55(5):401-7. doi: 10.1016/j.annemergmed.2009.03.014. Epub 2009 May 5. PubMed PMID: 19409657.
  4. Rajendran PM, Young D, Maurer T, Chambers H, Perdreau-Remington F, Ro P, Harris H. Randomized, double-blind, placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant Staphylococcus aureus infection. Antimicrob Agents Chemother. 2007 Nov;51(11):4044-8. PMID: 17846141; PubMed Central PMCID: PMC2151464.
  5. Llera JL, Levy RC. Treatment of cutaneous abscess: a double-blind clinical study. Ann Emerg Med. 1985 Jan;14(1):15-9. PubMed PMID: 3880635.
  6. Macfie J, Harvey J. The treatment of acute superficial abscesses: a prospective clinical trial. Br J Surg. 1977 Apr;64(4):264-6. PubMed PMID: 322789.
  7. Rutherford WH, Hart D, Calderwood JW, Merrett JD. Antibiotics in surgical treatment of septic lesions. Lancet. 1970 May 23;1(7656):1077-80. PMID: 4191960.

Studies undergoing review

  1. Gottlieb M, DeMott JM, Hallock M, Peksa GD. Systemic Antibiotics for the Treatment of Skin and Soft Tissue Abscesses: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2018 Mar 9. pii: S0196-0644(18)30142-2. doi: 10.1016/j.annemergmed.2018.02.011. PMID: 29530658.
  2. Vermandere M, Aertgeerts B, Agoritsas T, Liu C, Burgers J, Merglen A, et al. Antibiotics after incision and drainage for uncomplicated skin abscesses: a clinical practice guideline. BMJ. 2018 Feb 6;360:k243. doi: 10.1136/bmj.k243. PMID: 29437651.
  3. Wang W, Chen W, Liu Y, Siemieniuk RAC, Li L, Martínez JPD, Guyatt GH, Sun X. Antibiotics for uncomplicated skin abscesses: systematic review and network meta-analysis. BMJ Open. 2018 Feb 6;8(2):e020991. doi: 10.1136/bmjopen-2017-020991. PMID: 29437689.
  4. RCT of Clinda 1 vs 5 days (NCT01498744)
  5. Holmes L, Ma C, Qiao H, Drabik C, Hurley C, Jones D, Judkiewicz S, Faden H. Trimethoprim-Sulfamethoxazole Therapy Reduces Failure and Recurrence in Methicillin-Resistant Staphylococcus aureus Skin Abscesses after Surgical Drainage. J Pediatr. 2016 Feb;169:128-34.e1. doi: 10.1016/j.jpeds.2015.10.044. PMID: 26578074. 3 vs 7 days of TMP-SMX

Studies excluded - selected list of important studies
  1. Miller LG, Daum RS, Creech CB, Young D, Downing MD, Eells SJ, Pettibone S, Hoagland RJ, Chambers HF; DMID 07-0051 Team. Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated skin infections. N Engl J Med. 2015 Mar 19;372(12):1093-103. doi: 10.1056/NEJMoa1403789. PubMed PMID: 25785967 Could not isolate results for abscesses. Rutherford WH, Hart D, Calderwood JW, Merrett JD. Antibiotics in surgical treatment of septic lesions. Lancet. 1970 May 23;1(7656):1077-80. PubMed PMID: 4191960. Did not present results as rates

Funding for this review

  1. None.

Cited by

This repository is cited by:

  1. WikiDoc contributors. Goal-directed therapy. WikiDoc. Fef 24, 2015. Available at: http://www.wikidoc.org/index.php/Goal-directed_therapy. Accessed February 24, 2015.