Skin and soft-tissue infections requiring hospitalization at an academic medical center: opportunities for antimicrobial stewardship.
BACKGROUND
Although complicated skin and soft-tissue infections (SSTIs) are among the most common infections requiring hospitalization, their clinical spectrum, management, and outcomes have not been well described.


METHODS
We report a cohort of consecutive adult patients hospitalized for SSTI from 1 January through 31 December 2007 at an academic medical center. Cases meeting inclusion criteria were reviewed and classified as cellulitis, cutaneous abscess, or SSTI with additional complicating factors.


RESULTS
In total, 322 patients were included; 66 (20%) had cellulitis, 103 (32%) had cutaneous abscess, and 153 (48%) had SSTI with additional complicating factors. Injection drug use, diabetes mellitus, and alcohol abuse were common comorbidities. Serum inflammatory markers were routinely measured and blood cultures and imaging studies were routinely performed in each group. Of 150 patients with a positive culture result for an abscess, deep tissue, or blood, Staphylococcus aureus or streptococci were identified in 145 (97%). Use of antibiotics with broad aerobic gram-negative activity (61%-80% of patients) or anaerobic activity (73%-83% of patients) was frequent in each group. The median duration of therapy for cellulitis, cutaneous abscess, and SSTI with additional complicating factors was 13 (interquartile range [IQR], 10-14), 13 (IQR, 10-16), and 14 (IQR, 11-17) days, respectively. Treatment failure, recurrence, or rehospitalization due to SSTI within 30 days occurred in 12.1%, 4.9%, and 9.2% of patients, respectively.


CONCLUSIONS
Hospitalizations for SSTI were common; more than half were due to cellulitis or cutaneous abscess. Frequent use of potentially unnecessary diagnostic studies, broad-spectrum antibiotic therapy, and prolonged treatment courses in these patients suggest targets for antimicrobial stewardship programs.
Jenkins
Timothy C
TC
Department of Medicine and Division of Infectious Diseases, Denver Health Medical Center, University of Colorado Denver, Denver, CO, USA. timothy.jenkins@dhha.org
Sabel
Allison L
AL
Sarcone
Ellen E
EE
Price
Connie S
CS
Mehler
Philip S
PS
Burman
William J
WJ
D000046:Academic Medical Centers; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001769:Blood / Q000382:microbiology; D015331:Cohort Studies; D004363:Drug Utilization / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D017192:Skin Diseases, Bacterial / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology
D000900:Anti-Bacterial Agents