title: Bacteremia increases the risk of death among patients with soft-tissue infections.
abstract: BACKGROUND
  Soft-tissue infections traditionally have been viewed as carrying a lower risk of death than other types of infection such as pneumonia, blood stream, and intra-abdominal. The influence of secondary bacteremia on the outcomes of patients with soft-tissue infections is not well described.
  
  
  OBJECTIVE
  To describe the risk factors for bacteremia among patients admitted to an urban medical center with soft-tissue infections and the influence of bacteremia on outcomes.
  
  
  METHODS
  A retrospective cohort study of 717 patients with culture-positive non-necrotizing soft-tissue infections admitted between April 1, 2005, and December 31, 2007.
  
  
  RESULTS
  Bacteremia was present in 52% of the patients. Increasing age, previous hospitalization, decubitus or lower-extremity ulcers, device-related soft-tissue infection, and polymicrobial infection were independent predictors of bacteremia. Intensive care unit admission (adjusted odds ratio [AOR] 3.57; 95% confidence interval [CI] 2.17, 5.86), lower-extremity ulcer (AOR 3.43; 95% CI 2.07, 5.70), and bacteremia (AOR 6.37; 95% CI 3.34, 12.12) were independent predictors of in-hospital death. When patients with device-related soft-tissue infections were excluded, the rate of secondary bacteremia was 37.6% (201/535), and it remained an independent predictor of in-hospital death.
  
  
  CONCLUSIONS
  The occurrence of bacteremia in soft-tissue infections is associated with a greater risk of death. Health care providers should be aware of the risk factors for bacteremia in patients with soft-tissue infections in order to provide more appropriate initial antimicrobial therapy and to ascertain its presence as a prognostic indicator.
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri, USA.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.forename: Alex P
authors.initials: AP
authors.lastname: Hoban
authors.forename: Victor
authors.initials: V
authors.lastname: Pham
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Doherty
authors.forename: Marya D
authors.initials: MD
authors.lastname: Zilberberg
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Shorr
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D001424:Bacterial Infections / Q000382:microbiology / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000150:complications* / Q000401:mortality*; D016019:Survival Analysis; D055815:Young Adult