Abstract
The study is aimed at retrospectively estimating the percentage of inpatients with severe acute bacterial skin and skin structure infections (ABSSSI) who met the early discharged (ED) criteria adapted from Nathwani et al. (Int J Antimicrob Agents. 2016 Aug;48(2):127-36) and to calculate the number of hospitalization days that could be potentially saved. A retrospective study was conducted in a tertiary care hospital in Florence, Italy. We included all patients admitted for cellulitis and post-surgical infections from 2014 to 2017. Demographic and clinical data were obtained from electronic medical records. We a priori defined the following as a risk factor for non-adherence (RFNA): active or on methadone intravenous drug users, homeless, migrants without health care assistance, and patients who need a caregiver to take prescribed medications. One hundred sixty-two subjects were enrolled. Of them, 94 (58.0%) were male, and 113 (69.7%) had cellulitis/erysipelas. A microbiological isolate was obtained in 51 patients (31.4%); Staphylococcus aureus was the most frequent (47%). Eighty-four (51.8%) were ED suitable, with 258 (49.0%) patient days potentially saved. Among the 78 not ED suitable patients, the most common reason for prolonged length of stay (LOS) was having at least one RFNA (34.6%). Fourteen (18.0%) had one RFNA. Half of the patients admitted in our hospital met the ED criteria with a sparing close to 50% in terms of hospitalization days. Unstable social and personal factors were the most frequent causes for prolonged LOS. In this selected subset of patients, more recent and easier to administer treatments, including long-acting agents, could be proposed.
Highlights
In 2013, the United States (US) Food and Drug Administration (FDA) proposed new guidelines and recommendation on developing drugs for the treatment of skin and soft tissues infections, using a new definition of acute bacterial skin and skin structure infection (ABSSSI) [1]
We report the result of a study conducted in an Italian tertiary care teaching hospital focused on acute bacterial skin and skin-structure infection (ABSSSI) with the purpose to estimate the percentage of inpatients with ABSSSI who could be discharged earlier, based on adapted criteria from Nathwani et al and calculate the number of inpatient day that could have been saved [9]
A microbiological isolate was obtained in 51 subjects (31.4%), and S. aureus was the most frequent isolate (47.0%): methicillin-susceptible S. aureus (MSSA) in 17 cases (70.8%) and methicillin-resistant S. aureus (MRSA) in 7 (29.2%)
Summary
In 2013, the United States (US) Food and Drug Administration (FDA) proposed new guidelines and recommendation on developing drugs for the treatment of skin and soft tissues infections, using a new definition of acute bacterial skin and skin structure infection (ABSSSI) [1]. According to FDA, ABSSSI is defined as a bacterial infection of the skin with a lesion size area of at least 75 cm and the infection types included are cellulitis, erysipelas, major skin abscesses, and wound infections [1, 2]. Antibiotic-resistant bacteria such as methicillin-resistant S. aureus (MRSA) causing ABSSSI are more challenging to treat due to the lower availability of effective antibiotics and higher mortality rate [5]. The management of ABSSSI often requires intravenous antibiotic therapy and infection-source control through surgical debridement or abscess drainage [6]
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