Garau Javier, Blasi Francesco, Medina Jesús, McBride Kyle, Ostermann Helmut
Department of Medicine, Hospital Universitari Mutua de Terrassa, Plaza Doctor Robert 5, 08221, Terrassa, Barcelona, Spain.
Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ospedale Maggiore, Policlinico Cà Granda Milano, Milan, Italy.
BMC Infect Dis. 2015 Feb 19;15:78. doi: 10.1186/s12879-015-0822-2.
The treatment of complicated skin and soft tissue infections (cSSTI) is challenging and many patients do not receive adequate first-line therapy. REACH (REtrospective Study to Assess the Clinical Management of Patients With Moderate-to-Severe cSSTI or Community-Acquired Pneumonia in the Hospital Setting) was a retrospective observational study of cSSTI patients in real-life settings in European hospitals. In this analysis, we review characteristics and outcomes of patients with an early response (≤72 hours) compared with those without an early response to treatment. We also compare the results according to two differing definitions of early response, one of which (Definition 1) requires resolution of fever within 72 hours, in line with previous US FDA guidelines.
Patients were adults hospitalized with cSSTIs 2010-2011 and requiring treatment with intravenous antibiotics. Clinical management, clinical outcomes and healthcare resource use were assessed using a descriptive analysis approach.
The analysis set included 600 patients, of which 363 showed early response with Definition 1 and 417 with Definition 2. Initial treatment modification was frequent, and highest in patients without early response (48.1% with Definition 1). Patients without early response were more likely to have diabetes than those with early response (31.6% vs. 22.9%, respectively) and to suffer from more severe disease (e.g. skin necrosis: 14.8% and 7.7%, respectively), to be infected with difficult-to-treat microorganisms and to have recurrent infections. Furthermore, patients without early response had a higher rate of adverse clinical outcomes (e.g. septic shock) and higher use of healthcare resources. The results obtained with the two definitions for early response were largely similar.
This study highlights the significance of early evaluation of patients in hospitals, in potentially preventing prolonged use of inappropriate or ineffective antibacterial therapy.
NCT01293435 .
复杂性皮肤和软组织感染（cSSTI）的治疗具有挑战性，许多患者未接受充分的一线治疗。REACH（评估医院环境中中重度cSSTI或社区获得性肺炎患者临床管理的回顾性研究）是一项针对欧洲医院实际环境中cSSTI患者的回顾性观察研究。在本分析中，我们回顾了有早期反应（≤72小时）的患者与无早期反应患者的特征和结局。我们还根据两种不同的早期反应定义比较了结果，其中一种定义（定义1）要求在72小时内退热，这与美国食品药品监督管理局（FDA）先前的指南一致。
研究对象为2010 - 2011年因cSSTI住院且需要静脉使用抗生素治疗的成年患者。采用描述性分析方法评估临床管理、临床结局和医疗资源使用情况。
分析数据集包括600例患者，其中363例符合定义1的早期反应，417例符合定义2的早期反应。初始治疗调整很常见，在无早期反应的患者中发生率最高（定义1组为48.1%）。无早期反应的患者比有早期反应的患者更易患糖尿病（分别为31.6%和22.9%），病情更严重（如皮肤坏死：分别为14.8%和7.7%），感染难治疗的微生物，且有复发性感染。此外，无早期反应的患者不良临床结局（如感染性休克）发生率更高，医疗资源使用更多。两种早期反应定义的结果基本相似。
本研究强调了医院对患者进行早期评估的重要性，这可能有助于避免长期使用不适当或无效的抗菌治疗。
NCT01293435 。
