title: Epidemiology, treatment, and economics of patients presenting to the emergency department for skin and soft tissue infections.
abstract: OBJECTIVE
  Skin and soft tissue infections (SSTIs) are among the most common bacterial diseases and represent a significant disease burden. The purpose of this study was to describe the real-world management of patients with SSTIs presenting to the emergency department (ED).
  
  
  METHODS
  This is a retrospective cohort study. Adult patients identified with a primary diagnosis of SSTI determined by ICD-9 codes were assessed from index presentation for up to 30 days. Records were reviewed 30 days prior to inclusion to ensure index hospitalization was captured. For recurrent visits, a similar strategy was implemented 30 days afterward.
  
  
  RESULTS
  Of 446 encounters screened, 357 were included; 106 (29.7%) were admitted to the hospital and 251 (70.3%) were treated outpatient. Of patients with a Charlson Comorbidity Index (CCI) score two or greater, 60.9% were treated as inpatients, whereas admission rates were 30.1% and 14.1% for patients with a CCI score of one and zero, respectively. Inpatients had an average length of stay (LOS) of 7.3 ± 7.1 days. No difference was detected in overall re-presentation to the facility 22.6% and 28.3% (p > 0.05) or in SSTI related re-presentation 10.4% and 15.1% (p > 0.05) between inpatient and outpatients. The most common gram-positive organisms identified on wound/abscess culture were MSSA (37.1% inpatients) and MRSA (66.7% outpatients). Mean total cost of care was $13,313 for inpatients and $413 for outpatients.
  
  
  CONCLUSIONS
  This analysis identifies opportunities to improve processes of care for SSTIs with the aim of decreasing LOS, reducing readmissions, and ultimately decreasing burden on the healthcare system.
authors.affiliation: a Department of Pharmacy , Hartford Hospital , Hartford , CT , USA.
authors.forename: Kristin E
authors.initials: KE
authors.lastname: Linder
authors.affiliation: b Center for Anti-Infective Research and Development , Hartford Hospital , Hartford , CT , USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Nicolau
authors.affiliation: a Department of Pharmacy , Hartford Hospital , Hartford , CT , USA.|c Department of Pharmacy Practice , University of Connecticut School of Pharmacy , Storrs , CT , USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Nailor
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics* / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012874:Skin Diseases, Infectious / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D018461:Soft Tissue Infections / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology
keywords: Antimicrobial stewardship; readmission; skin and soft tissue infections