Kristin E Linder1, David P Nicolau2, Michael D Nailor1,3. 1. a Department of Pharmacy , Hartford Hospital , Hartford , CT , USA. 2. b Center for Anti-Infective Research and Development , Hartford Hospital , Hartford , CT , USA. 3. c Department of Pharmacy Practice , University of Connecticut School of Pharmacy , Storrs , CT , USA.
Abstract
OBJECTIVES: 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. CONCLUSION: 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.
OBJECTIVES: 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. CONCLUSION: 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.
Entities:
Keywords:
Antimicrobial stewardship; readmission; skin and soft tissue infections
Authors: Safa S Almarzoky Abuhussain; Michelle A Burak; Kelsey N Kohman; Gabrielle Jacknin; Serina B Tart; Athena L V Hobbs; Danyel K Adams; Michael D Nailor; Katelyn R Keyloun; David P Nicolau; Joseph L Kuti Journal: BMC Health Serv Res Date: 2018-12-04 Impact factor: 2.655
Authors: Li Jun Thean; Adam Jenney; Daniel Engelman; Lucia Romani; Handan Wand; Jyotishna Mudaliar; Jessica Paka; Tuliana Cua; Sera Taole; Aalisha Sahukhan; Mike Kama; Meciusela Tuicakau; Joseph Kado; Natalie Carvalho; Margot Whitfeld; John Kaldor; Andrew C Steer Journal: PLoS Negl Trop Dis Date: 2020-12-09