Linder Kristin E, Nicolau David P, Nailor Michael D
a Department of Pharmacy , Hartford Hospital , Hartford , CT , USA.
b Center for Anti-Infective Research and Development , Hartford Hospital , Hartford , CT , USA.
Hosp Pract (1995). 2017 Feb;45(1):9-15. doi: 10.1080/21548331.2017.1279519. Epub 2017 Jan 16.
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).
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.
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.
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.
皮肤和软组织感染（SSTIs）是最常见的细菌性疾病之一，且疾病负担较重。本研究旨在描述急诊科（ED）中SSTIs患者的实际管理情况。
这是一项回顾性队列研究。通过国际疾病分类第九版（ICD - 9）编码确定为主要诊断为SSTI的成年患者，从首次就诊起评估长达30天。在纳入前30天审查记录，以确保记录首次住院情况。对于复诊患者，在复诊后30天实施类似策略。
在筛查的446次就诊中，357次被纳入研究；106例（29.7%）住院治疗，251例（70.3%）门诊治疗。Charlson合并症指数（CCI）评分为2分或更高的患者中，60.9%接受住院治疗，而CCI评分为1分和0分的患者住院率分别为30.1%和14.1%。住院患者的平均住院时长（LOS）为7.3 ± 7.1天。住院患者和门诊患者再次到该机构就诊的总体比例分别为22.6%和28.3%（p > 0.05），与SSTI相关的再次就诊比例分别为10.4%和15.1%（p > 0.05），未检测到差异。伤口/脓肿培养中最常见的革兰氏阳性菌是甲氧西林敏感金黄色葡萄球菌（MSSA，住院患者中占37.1%）和耐甲氧西林金黄色葡萄球菌（MRSA，门诊患者中占66.7%）。住院患者的平均总护理费用为13,313美元，门诊患者为413美元。
本分析确定了改善SSTIs护理流程的机会，目的是缩短住院时长、减少再入院率，并最终减轻医疗系统的负担。
