TY - JOUR
T1 - Epidemiology and outcomes of hospitalizations with complicated skin and skin-structure infections
T2 - Implications of healthcare-associated infection risk factors
AU - Zilberberg, Marya D.
AU - Shorr, Andrew F.
AU - Micek, Scott T.
AU - Hoban, Alex P.
AU - Pham, Victor
AU - Doherty, Joshua A.
AU - Ramsey, Andrew M.
AU - Kollef, Marin H.
PY - 2009/12/1
Y1 - 2009/12/1
N2 - Objective. Healthcare-associated infections are likely to be caused by drug-resistant and possibly mixed organisms and to be treated with inappropriate antibiotics. Because prompt appropriate treatment is associated with better outcomes, we studied the epidemiology of healthcare-associated complicated skin and skin-structure infections (cSSSIs). patients. Persons hospitalized with cSSSI and a positive culture result. methods. We conducted a single-center retrospective cohort study from April 2006 through December 2007. We differentiated healthcareassociated from community-acquired cSSSIs by at least 1 of the following risk factors: (1) recent hospitalization, (2) recent antibiotics, (3) hemodialysis, and (4) transfer from a nursing home. Inappropriate treatment was defined as no antimicrobial therapy with activity against the offending pathogen(s) within 24 hours after collection of a culture specimen. Mixed infections were those caused by both a grampositive and a gram-negative organism. results. Among 717 hospitalized patients with cSSSI, 527 (73.5%) had healthcare-associated cSSSI. Gram-negative organisms were more common (relative risk, 1.24 [95% confidence interval, 1.14-1.35) and inappropriate treatment trended toward being more common (odds ratio, 1.29 [95% confidence interval, 0.85-1.95]) in healthcare-associated cSSSI than in community-acquired cSSSI. Mixed cSSSIs occurred in 10.6% of patients with healthcare-associated cSSSI and 6.3% of those with community-acquired cSSSI (P =.082) and were more likely to be treated inappropriately than to be nonmixed infections (odds ratio, 2.42 [95% confidence interval, 1.43-4.10]). Both median length of hospital stay (6.2 vs 2.9 days; P <.001) and mortality rate (6.6% vs 1.1%; P =.003) were significantly higher for healthcare-associated cSSSI than community-acquired cSSSI. conclusions. Healthcare-associated cSSSIs are common and are likely to be caused by gram-negative organisms. Mixed infections carry a >2-fold greater risk of inappropriate treatment. Healthcare-associated cSSSIs are associated with increased mortality and prolonged length of hospital stay, compared with community-acquired cSSSIs.
AB - Objective. Healthcare-associated infections are likely to be caused by drug-resistant and possibly mixed organisms and to be treated with inappropriate antibiotics. Because prompt appropriate treatment is associated with better outcomes, we studied the epidemiology of healthcare-associated complicated skin and skin-structure infections (cSSSIs). patients. Persons hospitalized with cSSSI and a positive culture result. methods. We conducted a single-center retrospective cohort study from April 2006 through December 2007. We differentiated healthcareassociated from community-acquired cSSSIs by at least 1 of the following risk factors: (1) recent hospitalization, (2) recent antibiotics, (3) hemodialysis, and (4) transfer from a nursing home. Inappropriate treatment was defined as no antimicrobial therapy with activity against the offending pathogen(s) within 24 hours after collection of a culture specimen. Mixed infections were those caused by both a grampositive and a gram-negative organism. results. Among 717 hospitalized patients with cSSSI, 527 (73.5%) had healthcare-associated cSSSI. Gram-negative organisms were more common (relative risk, 1.24 [95% confidence interval, 1.14-1.35) and inappropriate treatment trended toward being more common (odds ratio, 1.29 [95% confidence interval, 0.85-1.95]) in healthcare-associated cSSSI than in community-acquired cSSSI. Mixed cSSSIs occurred in 10.6% of patients with healthcare-associated cSSSI and 6.3% of those with community-acquired cSSSI (P =.082) and were more likely to be treated inappropriately than to be nonmixed infections (odds ratio, 2.42 [95% confidence interval, 1.43-4.10]). Both median length of hospital stay (6.2 vs 2.9 days; P <.001) and mortality rate (6.6% vs 1.1%; P =.003) were significantly higher for healthcare-associated cSSSI than community-acquired cSSSI. conclusions. Healthcare-associated cSSSIs are common and are likely to be caused by gram-negative organisms. Mixed infections carry a >2-fold greater risk of inappropriate treatment. Healthcare-associated cSSSIs are associated with increased mortality and prolonged length of hospital stay, compared with community-acquired cSSSIs.
UR - http://www.scopus.com/inward/record.url?scp=73449136390&partnerID=8YFLogxK
U2 - 10.1086/648083
DO - 10.1086/648083
M3 - Article
C2 - 19848604
AN - SCOPUS:73449136390
VL - 30
SP - 1203
EP - 1210
JO - Infection Control and Hospital Epidemiology
JF - Infection Control and Hospital Epidemiology
SN - 0899-823X
IS - 12
ER -