Skin and soft-tissue infections: Factors associated with mortality and re-admissions

• Published in: Enfermedades infecciosas y microbiologia clinica Vol. 35; no. 2; pp. 76 - 81
• Main Authors: Macía-Rodríguez, Cristina, Alende-Castro, Vanesa, Vazquez-Ledo, Lourdes, Novo-Veleiro, Ignacio, González-Quintela, Arturo
• Format: Journal Article
• Language: English
• Published: Spain Elsevier España, S.L.U 01.02.2017
• Subjects: Aged; Bacterias productoras de BLEE; ESBL-producing bacteria; Female; Healthcare-associated infections; Humans; Infecciones asociadas a los cuidados sanitarios; Infecciones de piel y partes blandas; Infectious Disease; Male; Mortalidad; Mortality; Patient Readmission - statistics & numerical data; Readmission; Reingreso; Retrospective Studies; Skin and soft-tissue infections; Skin Diseases, Infectious - microbiology; Skin Diseases, Infectious - mortality; Soft Tissue Infections - microbiology; Soft Tissue Infections - mortality; Skin and soft-tissue infections; Mortality; Healthcare-associated infections; ESBL-producing bacteria; Bacterias productoras de BLEE; Mortalidad; Reingreso; Readmission; Infecciones asociadas a los cuidados sanitarios; Infecciones de piel y partes blandas
• ISSN: 0213-005X; 1578-1852
• DOI: 10.1016/j.eimc.2016.02.030

Abstract Introduction Skin and soft-tissue infections (SSTIs) are common and are linked to a wide variety of clinical conditions. Few studies have analysed the factors associated with mortality and re-admissions in medical patients with SSTIs. Accordingly, this study sought to describe the clinical and microbiological characteristics of patients diagnosed with SSTIs, and identify mortality and re-admission related factors. Patients and methods A total of 308 patients were included in the study. Clinical, socio-demographic and microbiological characteristics were collected. Univariate and logistic regression multivariate analyses were performed in order to identify factors associated with mortality and re-admission. Results The bacteria responsible were identified in 95 (30.8%) patients, with gram-positive bacteria being isolated in 67.4% and gram-negative in 55.8% of cases. Multi-resistant bacteria were frequent (39%), and the initial empirical treatment proved inadequate in 25.3% of all cases. In-hospital mortality was 14.9%; the related variables were heart failure (OR = 5.96; 95%CI: 1.93–18.47), chronic renal disease (OR = 6.04; 95%CI: 1.80–20.22), necrotic infection (OR = 4.33; 95%CI: 1.26–14.95), and inadequate empirical treatment (OR = 44.74; 95%CI: 5.40–370.73). Six-month mortality was 8%, with the main related factors being chronic renal disease (OR: 3.03; 95%CI: 1.06–8.66), and a Barthel Index score of under 20 (OR: 3.62; 95%CI: 1.17–11.21). Re-admission was necessary in 26.3% of cases, with the readmission-related variables being male gender (OR: 2.12; 95%CI: 1.14–3.94), peripheral vascular disease (OR: 3.05; 95%CI: 1.25–7.41), and an age-adjusted Charlson Comorbidity Index score of over 3 (OR: 3.27; 95%CI: 1.40–7.63). Conclusions Clinical variables such as heart failure, chronic renal disease, peripheral vascular disease, and necrotic infection could help identify high-risk patients. The main factor associated with higher mortality was inadequate initial empirical treatment. Physicians should consider gram-negative, and even extended-spectrum beta-lactamase-producing bacteria when assigning initial empirical treatment for SSTIs, especially in healthcare-associated cases.