title: Rising United States Hospital Admissions for Acute Bacterial Skin and Skin Structure Infections: Recent Trends and Economic Impact.
abstract: BACKGROUND
  The number of ambulatory patients seeking treatment for skin and skin structure infections (SSSI) are increasing. The objective of this study is to determine recent trends in hospital admissions and healthcare resource utilization and identify covariates associated with hospital costs and mortality for hospitalized adult patients with a primary SSSI diagnosis in the United States.
  
  
  METHODS
  We performed a retrospective cross-sectional analysis (years 2005-2011) of data from the US Healthcare Cost and Utilization Project National Inpatient Sample. Recent trends, patient characteristics, and healthcare resource utilization for patients hospitalized with a primary SSSI diagnosis were evaluated. Descriptive and bivariate analyses were conducted to assess patient and hospital characteristics.
  
  
  RESULTS
  A total of 1.8% of hospital admissions for the years 2005 through 2011 were for adult patients with a SSSI primary diagnosis. SSSI-related hospital admissions significantly changed during the study period (P < .001 for trend) ranging from 1.6% (in 2005) to 2.0% (in 2011). Mean hospital length of stay (LOS) decreased from 5.4 days in the year 2005 to 5.0 days in the year 2011 (overall change, P < .001) with no change in hospital costs. Patients with postoperative wound infections had the longest hospital stays (adjusted mean, 5.81 days; 95% confidence interval (CI), 5.80-5.83) and highest total costs (adjusted mean, $9388; 95% CI, $9366-$9410). Year of hospital admission was strongly associated with mortality; infection type, all patient refined diagnosis related group severity of illness level, and LOS were strongly associated with hospital costs.
  
  
  CONCLUSIONS
  Hospital admissions for adult patients in the United States with a SSSI primary diagnosis continue to increase. Decreasing hospital inpatient LOS and mortality rate may be due to improved early treatment. Future research should focus on identifying alternative treatment processes for patients with SSSI that could shift management from inpatient to outpatient treatment settings.
authors.affiliation: Wayne State University and Detroit Medical Center, Detroit, Michigan, United States of America.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.affiliation: Pharmerit International, Bethesda, Maryland, United States of America.
authors.forename: Dipen A
authors.initials: DA
authors.lastname: Patel
authors.affiliation: Pharmerit International, Bethesda, Maryland, United States of America.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Stephens
authors.affiliation: Pharmerit International, Bethesda, Maryland, United States of America.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Khachatryan
authors.affiliation: Pharmerit International, Bethesda, Maryland, United States of America.
authors.forename: Ayush
authors.initials: A
authors.lastname: Patel
authors.affiliation: Durata Therapeutics, Chicago, Illinois, United States of America.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Johnson
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D006295:Health Resources; D006760:Hospitalization / Q000191:economics / Q000639:trends; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D012189:Retrospective Studies; D012307:Risk Factors; D017192:Skin Diseases, Bacterial / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult