Epidemiology and Outcomes of Complicated Skin and Soft Tissue Infections in Hospitalized Patients

Abstract

Complicated skin and soft tissue infections (cSSTIs) are among the most rapidly increasing reasons for hospitalization. To describe inpatients with regard to patient characteristics, cSSTI origin, appropriateness of initial antibiotics, and outcomes, we performed a retrospective cohort study in patients hospitalized for cSSTI. To identify independent predictors of outcomes, we performed multivariate analyses. Of 1,096 eligible patients, 48.7% had health care-associated (HCA) cSSTI and 51.3% had community-acquired (CA) cSSTI. After adjustment for baseline variables, hospital length of stay (LOS) was longer for HCA than for CA cSSTI (difference, 2.1 days; 95% confidence interval [CI], 0.8 to 3.5; P < 0.05). Other covariates associated with a longer LOS were need for dialysis (regression coefficient ؎ standard error, 4.5 ؎ 1.1) and diabetic wound diagnosis (2.6 ؎ 1.0) (all P < 0.05). In the subset with culture-positive cSSTI within 24 h of admission, the most common pathogen was Staphylococcus aureus (298/449 [66.4%]), of which 74.8% (223/298) were methicillin-resistant S. aureus (MRSA). Eighty-three patients (18.5%) received inappropriate initial antibiotics. After adjustment for other variables, the following were associated with inappropriate initial therapy: direct admission to hospital (not via emergency department), cSSTI caused by MRSA or mixed pathogens, and cSSTI caused by pathogens other than S. aureus or streptococci (all P < 0.05). We did not find an association between inappropriate therapy and outcomes, except in the subset with ulcers (adjusted odds ratio, 11.8; 95% CI, 1.3 to 111.1; P ‫؍‬ 0.03). More studies are needed to examine the impact of HCA cSSTI and inappropriate initial therapy on outcomes.

Clinico-microbiological study of community acquired and health care associated methicillin-resistant Staphylococcus aureus from skin and soft tissue infections

“…The findings of this study correlate with the observations from many previous studies that SSTIs due to HA-MRSA are more prevalent among extremes of age, as in elderly and neonatal population. [6][7][8][9][10]14 On the other hand, we observed that the majority of CA-MRSA patients were children in the age group of 1-10 years (26.9%), with patients of age group greater than 50 contributing to only 5.7%. A study by Larsen et al showed similar results with children (1 to 10 years old) constituting 25.3% of all CA-MRSA cases.…”

A Study on MRSA Isolates in MCH Microbiology Lab, Medical College Hospital, Thiruvanantapuram

“…Most of the HA-MRSA infections presented as cellulitis ,32(34.04%) followed by post operative wound infections, 27(28.72%), followed by abscess, 24(25.53%)). Zervos et al (2012) reported that health care associated completed SST were more likely to present as surgical site infections and ulcer. 12 Since children less than 10 yrs are not much involved among CA-MRSA patients, the risk factors for acquisition of CA-MRSA were not statistically significant in the present study.…”

“…Zervos et al (2012) reported that health care associated completed SST were more likely to present as surgical site infections and ulcer. 12 Since children less than 10 yrs are not much involved among CA-MRSA patients, the risk factors for acquisition of CA-MRSA were not statistically significant in the present study. HA-MRSA infections definitely possess many risk factors which poses a hazard to hospitalized patients.…”

Telavancin (VIBATIV) for the treatment of complicated skin and skin structure infections

“…In 2004, MRSA was the most commonly identifiable organism in patients with cSSSIs presenting at 11 emergency departments across the USA [2]. In a more recent retrospective study of cSSSIs in hospitalized patients, 66.4% of cultures grew S. aureus, of which 74.8% were MRSA [3].…”