title: A prospective, multicenter, observational study of complicated skin and soft tissue infections in hospitalized patients: clinical characteristics, medical treatment, and outcomes.
abstract: BACKGROUND
  Complicated skin and soft tissue infections (cSSTIs) occur frequently, but limited data do not allow any consensus on an optimal treatment strategy. We designed this prospective, multicenter, observational study to to explore the current epidemiology, treatment, and resulting clinical outcomes of cSSTIs to help develop strategies to potentially improve outcomes.
  
  
  METHODS
  From June 2008 to December 2009 we enrolled a pre-specified number of adults treated in 56 U.S. hospitals with intravenous antibiotic(s) for any of the following cSSTIs: diabetic foot infection (DFI); surgical site infection (SSI); deep soft tissue abscess (DSTA); or, cellulitis. Investigators treated all patients per their usual practice during the study and collected data on a standardized form.
  
  
  RESULTS
  We enrolled 1,033 patients (DFI 27%; SSI 32%; DSTA 14%; cellulitis 27%; mean age 54 years; 54% male), of which 74% had healthcare-associated risk factors. At presentation, 89% of patients received initial empiric therapy with intravenous antibiotics; ~20% of these patients had this empiric regimen changed or discontinued based on culture and sensitivity results. Vancomycin was the most frequently used initial intravenous antibiotic, ordered in 61% of cases. During their stay 44% of patients underwent a surgical procedure related to the study infection, usually incision and drainage or debridement. The mean length of stay was 7.1 days, ranging from 5.8 (DSTA) to 8.1 (SSI).
  
  
  CONCLUSIONS
  Our findings from this large prospective observational study that characterized patients with cSSTIs from diverse US inpatient populations provide useful information on the current epidemiology, clinical management practices and outcomes of this common infection.
authors.affiliation: VA Puget Sound Health Care System & University of Washington, Seattle, WA, USA. dblipsky@hotmail.com
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Lipsky
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Moran
authors.forename: Lena M
authors.initials: LM
authors.lastname: Napolitano
authors.forename: Lien
authors.initials: L
authors.lastname: Vo
authors.forename: Susan
authors.initials: S
authors.lastname: Nicholson
authors.forename: Myoung
authors.initials: M
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017192:Skin Diseases, Bacterial / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents