title: Resource use in patients hospitalized with complicated skin and soft tissue infections in Europe and analysis of vulnerable groups: the REACH study.
abstract: BACKGROUND
  Hospitalized patients with complicated skin and soft tissue infections (cSSTI) present a substantial economic burden, and resource use can vary according to the presence of comorbidities, choice of antibiotic agent, and the requirement for initial treatment modification. REACH (NCT01293435) was a retrospective, observational study aimed at collecting empirical data on current (year 2010-2011) management strategies of cSSTI in 10 European countries.
  
  
  METHODS
  Patients (n = 1995) were aged ≥18 years, hospitalized with a cSSTI and receiving intravenous antibiotics. Data, collected via electronic Case Report Forms, detailed patient characteristics, medical history, disease characteristics, microbiological diagnosis, disease course and outcomes, treatments before and during hospitalization, and health resource consumption.
  
  
  RESULTS
  For the analysis population, mean length of hospital stay (including duration of hospitalizations for patients with recurrences) was 18.5 days (median 12.0). Increased length of hospital stay was found for patients with comorbidities vs those without (mean = 19.9; [median = 14.0] days vs 13.3 [median = 8.0] days), for patients with methicillin-resistant Staphylococcus aureus compared with patients with methicillin-sensitive S. aureus (mean = 27.7 [median = 19.5] days vs 18.4 [median = 13.0] days) and for patients requiring surgery (mean = 24.4 [median = 16.0] days vs 15.0 [median = 11.0] days). Patients requiring modification of their initial antibiotic treatment had an associated increase in mean length of hospital stay of 10.9 days (median = 6.5) and additional associated hospital resource use. A multivariate analysis confirmed the association of nosocomial infections, comorbidities, directed treatment, recurrent infections, diabetes, recent surgery, and older age (≥65 years), with longer hospital stay.
  
  
  CONCLUSIONS
  This study provides real-life data on factors that are expected to impact length of hospital stay, to guide clinical decision-making to improve outcomes, and reduce resource use in patients with cSSTI.
authors.affiliation: Department of Internal Medicine III, Haematology and Oncology, University Hospital Munich , Munich , Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Ostermann
authors.forename: Francesco
authors.initials: F
authors.lastname: Blasi
authors.forename: Jesús
authors.initials: J
authors.lastname: Medina
authors.forename: Esther
authors.initials: E
authors.lastname: Pascual
authors.forename: Kyle
authors.initials: K
authors.lastname: McBride
authors.forename: Javier
authors.initials: J
authors.lastname: Garau
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D015897:Comorbidity; D005060:Europe; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000191:economics*; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000191:economics*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Anti-bacterial agents; Complicated skin and soft tissue infections; Europe; Resource use; Retrospective study; Vulnerable groups