Outcomes and management costs in patients hospitalized for skin and skin-structure infections.
BACKGROUND
This study was conducted to determine outcomes and costs of treating complicated skin and skin-structure infections (cSSSIs) due to gram-positive only, gram-negative only, or mixed pathogens (gram-positive and gram-negative), including those with methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa.


METHODS
Data on length of stay (LOS), mortality, and charges for cSSSIs were compiled from claims in the multihospital Solucient database from 2002 to 2006.


RESULTS
Among the 5156 cases with pathogens identified, 59.7% were gram-positive, 21.5% were gram-negative, and 18.8% were mixed. Patients with mixed pathogens incurred significantly higher LOS (17.2 days), mortality (10.2%), and charges ($80,093) than those with cSSSIs due to gram-negative pathogens (10.1 days, 6.5%, and $41,634, respectively) or to gram-positive pathogens (9.5 days, 4.8%, and $40,046, respectively). MRSA was isolated from 21.6% of all cases and from 26.3% of cases involving mixed pathogens. MRSA cases had significantly longer LOS and greater mortality than non-MRSA cases, but similar total charges. P aeruginosa occurred in 13.3% of all cases and in 36.3% of cases involving mixed pathogens. P aeruginosa cases had significantly higher LOS and charges compared with non‒P aeruginosa cases.


CONCLUSIONS
Although gram-positive pathogens were the most common causes of cSSSIs, cases involving mixed and resistant pathogens were associated with longer LOS, greater mortality, and higher total charges.
Itani
Kamal M F
KM
Boston Veterans Affairs Health Care System and Boston University, 1400 VFW Pkwy., West Roxbury, MA 02132, USA. kitani@va.gov
Merchant
Sanjay
S
Lin
Swu-Jane
SJ
Akhras
Kasem
K
Alandete
Juan Carlos
JC
Hatoum
Hind T
HT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D005260:Female; D017048:Health Care Costs; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017192:Skin Diseases, Bacterial / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents