Incidence and factors associated with emergency department visits for recurrent skin and soft tissue infections in patients in California, 2005–2011

Abstract

More than 2 million visits for skin and soft tissue infections (SSTIs) are seen in US emergency departments (EDs) yearly. Up to 50% of patients with SSTIs, suffer from recurrences, but associated factors remain poorly understood. We performed a retrospective study of patients with primary diagnosis of SSTI between 2005 and 2011 using California ED discharge data from the State Emergency Department Databases and State Inpatient Databases. Using a multivariable logistic regression, we examined factors associated with a repeat SSTI ED visits up to 6 months after the initial SSTI. Among 197 371 SSTIs, 16·3% were associated with a recurrent ED visit. We found no trend in recurrent visits over time (χ 2 trend = 0·68, P = 0·4). Race/ethnicity, age, geographical location, household income, and comorbidities were all associated with recurrent visits. Recurrent ED visits were associated with drug/alcohol abuse or liver disease [odds ratio (OR) 1·4, 95% confidence interval (CI) 1·3-1·4], obesity (OR 1·3, 95% CI 1·2-1·4), and in infections that were drained (OR 1·1, 95% CI 1·1-1·1) and inversely associated with hospitalization after initial ED visit (OR 0·4, 95% CI 0·3-0·4). In conclusion, we found several patient-level factors associated with recurrent ED visits. Identification of these high-risk groups is critical for future ED-based interventions.

National Costs Associated With Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus Hospitalizations in the United States, 2010–2014

“…Because skin and soft tissue infections (SSTIs) primarily drive the dynamics of other S. aureus hospitalizations [4, 5], we also conducted an analysis of cost differences among MRSA- and MSSA-related hospitalizations with and without SSTIs. Skin and soft tissue infections were classified as any “other” S. aureus hospitalization (based on the aforementioned definition) that included an SSTI ICD-9 code defined in May et al [20]. The included codes were carbuncle and furuncle (680.xx), cellulitis and abscess of finger and toe (681.xx), impetigo (684.xx), other cellulitis and abscess (682.xx), other local infections of skin and subcutaneous tissue (686.xx), inflammatory disease of breast (611.0), other specified diseases of hair and hair follicles (704.8), and erysipelas (35).…”

Afabicin, a First-in-Class Antistaphylococcal Antibiotic, in the Treatment of Acute Bacterial Skin and Skin Structure Infections: Clinical Noninferiority to Vancomycin/Linezolid

“…Furthermore, a high proportion of patients in the study were obese (BMI ≥ 30 kg/m²). Both drug abuse and obesity have been associated with recurrent emergency department visits (30) The IDSA guidelines for the treatment of severe ABSSSI include use of vancomycin, linezolid, daptomycin and telavancin (3); however, there are safety concerns related to these agents (4-7), underscoring the need for extending the available treatment options. In addition, more recently approved agents such as dalbavancin can be considered in this indication (31).…”

“…Furthermore, a high proportion of patients in the study were obese (body mass index [BMI] ≥ 30 kg/m 2 ). Both drug abuse and obesity have been associated with recurrent emergency department visits ( 28 ). Despite the potential complications of a population with such comorbidities, 84.8% of randomized patients completed the study up to STFU.…”

Management of acute bacterial skin and skin structure infections with a focus on patients at high risk of treatment failure

“…68 Recognizing patient and disease risk factors is key to avoiding treatment failure. Among patients treated in emergency departments in the United States, initial treatment failure was associated with a variety of patient-level factors, 76 including income, drug/alcohol abuse, obesity, drained infection, and age. 76,77 In one of these studies, patients older than 65 years were nearly fourtimes more likely to fail initial therapy compared with younger patients (OR: 3.87), the chances of failure increasing by 43% with every 10-year increase in age.…”