Quality, Safety and Informatics Research Group, Division of Clinical and Population Sciences and Education, Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, Scotland, UK.
J Antimicrob Chemother. 2011 Feb;66(2):387-97. doi: 10.1093/jac/dkq362. Epub 2010 Oct 5.
Skin and soft tissue infections (SSTIs) are caused by bacterial invasion of the skin and underlying soft tissues and can present with a wide spectrum of signs, symptoms and illness severity. They are a common indication for antimicrobial therapy. However, there are few data on treatment outcomes or the validity of clinical severity scores.
Two hundred and five adult patients admitted to Ninewells Hospital, Scotland in 2005, and treated with antibiotics for SSTI, were identified. They were stratified into four classes of severity (class IV = most severe) based on sepsis, co-morbidity and their standardized early warning score (SEWS). Empirical antimicrobial therapy by severity class was compared with the recommendations of a UK guideline.
Thirty-five different empirical antimicrobial regimens were prescribed. Overall, 43% of patients were over-treated, this being particularly common in the lowest severity class I (65% patients). Thirty-day mortality was 9% (18/205) and 17 patients (8%) died during their index admission. Mortality (30 day) and inadequate therapy increased with severity class: I, no sepsis or co-morbidity (45% patients, 1% mortality, 14% therapy inadequate); II, significant co-morbidity but no sepsis (32% patients, 11% mortality, 39% therapy inadequate); III, sepsis but SEWS <4 (17% of patients, 17% mortality, 39% therapy inadequate); and IV, sepsis plus SEWS ≥ 4 (6% of patients, 33% mortality, 92% therapy inadequate).
SSTI in hospital is associated with significant mortality. Choice of empirical therapy is not evidence based, with significant under-treatment of severely ill patients.
皮肤和软组织感染（SSTIs）是由细菌入侵皮肤和皮下软组织引起的，可表现出广泛的体征、症状和疾病严重程度。它们是抗菌治疗的常见指征。然而，关于治疗结果或临床严重程度评分的有效性的数据很少。
2005 年，苏格兰 Ninewells 医院收治了 205 例成人 SSTI 患者，这些患者接受了抗生素治疗。根据脓毒症、合并症和标准化早期预警评分（SEWS），将他们分为四级严重程度（IV 级=最严重）。根据严重程度分级，对经验性抗菌治疗与英国指南的建议进行了比较。
共开出了 35 种不同的经验性抗菌方案。总体而言，43%的患者治疗过度，这在最低严重程度的 I 级（65%的患者）中尤其常见。30 天死亡率为 9%（18/205），17 名患者（8%）在入院期间死亡。死亡率（30 天）和治疗不足随着严重程度的增加而增加：I 级，无脓毒症或合并症（45%的患者，1%的死亡率，14%的治疗不足）；II 级，有严重合并症但无脓毒症（32%的患者，11%的死亡率，39%的治疗不足）；III 级，脓毒症但 SEWS<4（17%的患者，17%的死亡率，39%的治疗不足）；IV 级，脓毒症加 SEWS≥4（6%的患者，33%的死亡率，92%的治疗不足）。
医院内的 SSTI 与显著的死亡率相关。经验性治疗的选择不是基于证据的，严重疾病患者的治疗不足。
