Community antibiotic management of skin infections in the Torres Strait
Allison Hempenstall
A * , Pelista Pilot A , Malcolm McDonald B , Simon Smith C and Josh Hanson C D
A Torres and Cape Hospital and Health Service, Thursday Island, Qld, Australia.
B James Cook University, Cairns, Qld, Australia.
C Cairns Hospital and Hinterland Health Service, Cairns, Qld, Australia.
D The Kirby Institute, University of New South Wales, Kensington, NSW, Australia.
Australian Journal of Primary Health 29(1) 91-98 https://doi.org/10.1071/PY22142
Submitted: 11 July 2022 Accepted: 28 September 2022 Published: 21 October 2022
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University
Abstract
Background: There is a high burden of skin and soft tissue infections (SSTI) – including cellulitis – among Aboriginal and Torres Strait Islander peoples living in remote communities. In tropical environments, such as the Torres Strait, cellulitis accounts for 37% of potentially preventable hospitalisations. This study aimed to evaluate the safety, effectiveness and community acceptance of outpatient antibiotic treatment for the management of skin infections in the Torres Strait.
Methods: This was a 12-month prospective, observational study commencing in January 2019 involving 295 adults with a skin infection across the Torres Strait.
Results: Most (276/295 (94%)) participants were treated successfully in the community. Of 295 enrolled patients, 151 of 295 (51%) had cellulitis, 59 of 295 (20%) had a skin abscess and 85 of 295 (28%) had a wound infection. Of the 77 of 278 (27%) infections accompanied by systemic features, 63 of 77 (82%) were managed in the community. Staphylococcus aureus was the most frequent isolate, at 165 of 261 (63%); 56 of 165 (33%) were methicillin resistant. In the 276 community-managed cases, oral trimethoprim/sulfamethoxazole was initially used in 159 (57%), oral flucloxacillin in 75 (27%) and intravenous cefazolin plus oral probenecid in 32 (13%). The clinical course was complicated in eight of 232 (3%) patients who had complete follow-up data: seven patients required hospitalisation after initial treatment in the community and one had an antibiotic side-effect. All 232 patients with complete follow-up data were content with the care they received.
Conclusions: Outpatient management of skin infection in the Torres Strait is effective, safe and appreciated by patients.
Keywords: Aboriginal and Torres Strait Islander, antibiotics, infectious disease, outpatient management, public health, rural health, skin and soft tissue infections, skin disease.
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