Cellulitis and Abscess Management in the Era of Resistance to Antibiotics (CAMERA)

Final Contract Report

Final Contract Report

The Agency for Healthcare Research and Quality's Practice-Based Research Networks in North Carolina conducted a 2-year project related to infections caused by community acquired methicillin-resistant Staphylococcus aureus. Cellulitis and Abscess Management in the Era of Resistance to Antibiotics (CAMERA) is the final contract report for the project.

Prepared for the Agency for Healthcare Research and Quality (AHRQ) by the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, and the Duke Clinical Research Institute, Durham, North Carolina under Contract No. HHSA-290-2007-10014.

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Prepared by: Philip D Sloane, M.D., M.P.H. and Alex R. Kemper, M.D., M.P.H., M.S.; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill; Duke Clinical Research Institute, Durham, North Carolina.

Contents

Acknowledgments
Disclaimer
Copyright Information
Introduction
Study Goals
Overview of Study Interventions
Study Setting
Participating Practices
Human Subjects Protection and Subject Followup
Study Measures
Practice Duration of Enrollment
Barriers to Practice Participation
Findings
   Diagnosis
   Abscess Treatment
   Practice Followup
Conclusions
Recommendations
Dissemination of Findings References

Tables
Table 1. Characteristics of Participating Practices
Table 2. Duration of Practice Enrollment
Table 3. Number of abscesses and the total number of skin or soft tissue infections, by practice and audit point
Table 4. Proportion with culture by treatment
Table 5. Initial antibiotic therapy for those with an abscess
Table 6. Rates of followup within each practice after the diagnosis of an abscess or other skin or soft tissue infection
Table 7. Rate of emergency department or urgent care followup or hospitalization by age

Appendixes
Appendix A. Skin and Soft Tissue Infection Action Plan
Appendix B. Skin and Soft Tissue Culture Kit
Appendix C. Skin and Soft Tissue Patient Information Material
Appendix D.
   Part 1: MRSA: Epidemiology and Treatment
   Part 2: Implementing the CDC Recommendations: Can it be done? What lessons can be learned?
Appendix E. Patient Diary
Appendix F. Chart Audit Instrument

Acknowledgments

We would like to thank the following practices for their participation:

A.J. Robinson Medical Clinic, Lumberton, NC
Chapel Hill Pediatrics, Chapel Hill, NC
Clayton Internal Medicine, Clayton, NC
Duke Primary Care Harps Mill, Raleigh, NC
Durham Pediatrics, Durham, NC
Lumberton Children's Clinic, Lumberton, NC
Pembroke Pediatrics, Pembroke, NC
Regional Pediatrics, Durham, NC
St. Paul's Internal Medicine, Lumberton, NC

This project was completed in partnership between the University of North Carolina, Chapel Hill, and Duke University. We would like to acknowledge the following individuals.

Alex R. Kemper, M.D., M.P.H., M.S., Principal Investigator (Duke University)
Rowena J. Dolor, M.D., M.H.S., Co-Investigator (Duke University)
Philip D. Sloane, M.D., M.P.H., Co-Investigator (University of North Carolina)
Katrina Donahue, M.D., M.P.H., Co-Investigator (University of North Carolina)
Vance Fowler, M.D., M.P.H., Co-investigator (Duke University)
Beth Patterson, R.N., B.S.N., Clinical Research Administrator (Duke University)
Lori Hendrickson, R.N., B.S.N., Clinical Research Coordinator (Duke University)
Lynn Harrington, R.N., B.S.N., Clinical Research Coordinator (Duke University)
Luis Ballon, Clinical Trials Assistant (Duke University)
Latosha Oxendine, Clinical Trials Assistant (Duke University)
C. Madeline Mitchell, MURP, Research Fellow (University of North Carolina)
David Reed, Ph.D., Statistician (University of North Carolina)

Disclaimer

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of the Agency for Healthcare Research and Quality (AHRQ). No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

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Copyright

This document is in the public domain and may be used and reprinted without permission. AHRQ appreciates citation of the source.

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