Complicated skin and skin structure infections in alcoholics, a retrospective cohort study

Abstract

Background Alcoholism increases the risk of skin and skin structure infections (SSSIs). Furthermore, in complicated SSSIs (cSSSIs) alcoholism is associated with delayed treatment response and a higher risk of blood culture positivity, suggesting poor outcomes. In pneumonia and bacteremia alcoholism is linked with higher mortality, longer hospital treatment and more ICU treatment. Methods We conducted a population-based retrospective cohort study including all cases of complicated skin and skin structure infections (n = 460) treated in Gothenburg, Sweden and Helsinki, Finland from 2008 − 2011. Patients were stratified as alcoholics (9%) and non-alcoholics (91%) and patient and disease factors, treatment, and outcomes were compared. Results Alcoholics were comparatively younger and more often male, with more liver diseases. We observed higher rates of bacteraemia, intensive care unit admission, surgical intervention, and clinical failure in alcoholics. Alcoholism was associated with longer length of stay and more interdepartmental transfers. We did not observe differences in infection type or time from symptom onset to diagnosis. Mortality was low and equivalent in alcoholics and non-alcoholics. Conclusions Alcoholism is associated with increased cSSSI disease severity and resource utilisation.