VA Puget Sound Health Care System & University of Washington, Seattle, WA, USA.
BMC Infect Dis. 2012 Sep 25;12:227. doi: 10.1186/1471-2334-12-227.
Complicated skin and soft tissue infections (cSSTIs) occur frequently, but limited data do not allow any consensus on an optimal treatment strategy. We designed this prospective, multicenter, observational study to to explore the current epidemiology, treatment, and resulting clinical outcomes of cSSTIs to help develop strategies to potentially improve outcomes.
From June 2008 to December 2009 we enrolled a pre-specified number of adults treated in 56 U.S. hospitals with intravenous antibiotic(s) for any of the following cSSTIs: diabetic foot infection (DFI); surgical site infection (SSI); deep soft tissue abscess (DSTA); or, cellulitis. Investigators treated all patients per their usual practice during the study and collected data on a standardized form.
We enrolled 1,033 patients (DFI 27%; SSI 32%; DSTA 14%; cellulitis 27%; mean age 54 years; 54% male), of which 74% had healthcare-associated risk factors. At presentation, 89% of patients received initial empiric therapy with intravenous antibiotics; ~20% of these patients had this empiric regimen changed or discontinued based on culture and sensitivity results. Vancomycin was the most frequently used initial intravenous antibiotic, ordered in 61% of cases. During their stay 44% of patients underwent a surgical procedure related to the study infection, usually incision and drainage or debridement. The mean length of stay was 7.1 days, ranging from 5.8 (DSTA) to 8.1 (SSI).
Our findings from this large prospective observational study that characterized patients with cSSTIs from diverse US inpatient populations provide useful information on the current epidemiology, clinical management practices and outcomes of this common infection.
复杂皮肤和软组织感染（cSSTIs）频繁发生，但有限的数据无法就最佳治疗策略达成共识。我们设计了这项前瞻性、多中心、观察性研究，以探索 cSSTIs 的当前流行病学、治疗方法和临床结果，以帮助制定策略，可能改善治疗结果。
我们从 2008 年 6 月至 2009 年 12 月，在 56 家美国医院招募了经静脉用抗生素治疗的规定数量的成年患者，这些患者患有以下任何一种 cSSTIs：糖尿病足感染（DFI）；手术部位感染（SSI）；深部软组织脓肿（DSTA）；或蜂窝织炎。研究者根据研究期间的常规做法治疗所有患者，并使用标准化表格收集数据。
我们共招募了 1033 名患者（DFI 占 27%；SSI 占 32%；DSTA 占 14%；蜂窝织炎占 27%；平均年龄 54 岁；54%为男性），其中 74%有与医疗保健相关的危险因素。在就诊时，89%的患者接受了初始经验性静脉内抗生素治疗；约 20%的患者根据培养和药敏结果改变或停止了初始经验性治疗方案。万古霉素是最常使用的初始静脉内抗生素，61%的患者使用了该药。在住院期间，44%的患者接受了与研究感染相关的手术，通常是切开引流或清创术。平均住院时间为 7.1 天，范围为 5.8（DSTA）至 8.1（SSI）天。
我们从这项大型前瞻性观察性研究中得出的结果，描述了来自美国不同住院患者人群的 cSSTIs 患者的情况，为这种常见感染的当前流行病学、临床管理实践和结果提供了有用的信息。
