Abstract
BackgroundComplicated skin and soft tissue infections (cSSTIs) occur frequently, but limited data do not allow any consensus on an optimal treatment strategy. We designed this prospective, multicenter, observational study to to explore the current epidemiology, treatment, and resulting clinical outcomes of cSSTIs to help develop strategies to potentially improve outcomes.MethodsFrom June 2008 to December 2009 we enrolled a pre-specified number of adults treated in 56 U.S. hospitals with intravenous antibiotic(s) for any of the following cSSTIs: diabetic foot infection (DFI); surgical site infection (SSI); deep soft tissue abscess (DSTA); or, cellulitis. Investigators treated all patients per their usual practice during the study and collected data on a standardized form.ResultsWe enrolled 1,033 patients (DFI 27%; SSI 32%; DSTA 14%; cellulitis 27%; mean age 54 years; 54% male), of which 74% had healthcare-associated risk factors. At presentation, 89% of patients received initial empiric therapy with intravenous antibiotics; ~20% of these patients had this empiric regimen changed or discontinued based on culture and sensitivity results. Vancomycin was the most frequently used initial intravenous antibiotic, ordered in 61% of cases. During their stay 44% of patients underwent a surgical procedure related to the study infection, usually incision and drainage or debridement. The mean length of stay was 7.1 days, ranging from 5.8 (DSTA) to 8.1 (SSI).ConclusionOur findings from this large prospective observational study that characterized patients with cSSTIs from diverse US inpatient populations provide useful information on the current epidemiology, clinical management practices and outcomes of this common infection.
Highlights
Complicated skin and soft tissue infections occur frequently, but limited data do not allow any consensus on an optimal treatment strategy
Despite the frequent occurrence of Complicated skin and soft tissue infections (cSSTIs), our current understanding is limited about their clinical characteristics at presentation, how they are treated in actual clinical settings, and what the outcomes are of treatment
Study population Patients aged ≥18 years were eligible for this study if they were: hospitalized with signs and symptoms of infection consistent with a diagnosis of diabetic foot infection (DFI), surgical site infection (SSI), deep soft tissue abscess (DSTA), or cellulitis, as defined in the protocol; had an expected inpatient stay for treatment of the study infection of ≥48 h; and, were treated with intravenous antibiotic agents as the primary regimen during the inpatient episode
Summary
Complicated skin and soft tissue infections (cSSTIs) occur frequently, but limited data do not allow any consensus on an optimal treatment strategy. We designed this prospective, multicenter, observational study to to explore the current epidemiology, treatment, and resulting clinical outcomes of cSSTIs to help develop strategies to potentially improve outcomes. While there is currently no clear consensus on how to manage these infections, treatment virtually always includes administering antibiotic therapy and often requires concomitant drainage and debridement procedures. The management approach depends on many factors, including the infection type and severity, epidemiologic setting, likely causative pathogens, and local antibiotic resistance patterns [2,6,7,8]. Despite the frequent occurrence of cSSTIs, our current understanding is limited about their clinical characteristics at presentation, how they are treated in actual clinical settings, and what the outcomes are of treatment
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