a Department of Infectious Diseases , Inflammation Center, Helsinki University Central Hospital, and Helsinki University , Helsinki , Finland.
b Department of Infectious Diseases , Institute of Biomedicine, Sahlgrenska Academy University of Gothenburg , Gothenburg , Sweden.
Infect Dis (Lond). 2018 Feb;50(2):107-116. doi: 10.1080/23744235.2017.1362706. Epub 2017 Aug 8.
Management practices of complicated skin and skin structure infections (cSSSI) were compared between two areas with similar healthcare structure and low prevalence of antimicrobial resistance.
The high affinity to public health-care in the Nordic countries enabled population-based approach used in this retrospective study. The study population (n = 460) consisted of all adult residents from Helsinki (Finland) and Gothenburg (Sweden) treated in hospital due to cSSSI during 2008-2011.
The majority of patients in Helsinki (57%) visited more than one ward during their hospital stay while in Gothenburg the majority of patients (85%) were treated in one ward only. Background and disease characteristics were largely similar in both cities but patients in Helsinki were younger [mean(SD) 59(18) versus 63(19) years, p = .0117], and greater proportions had diabetes (50% versus 32%, p < .0001) and polymicrobial infections (34% versus 13%, p < .0001). Patients in Helsinki received antimicrobials with Gram-negative coverage (in initial therapy 96%) more frequently than in Gothenburg (47%, p < .0001), had more treatment modifications (mean 4.3 versus 2.7 antibiotic agents used per patient, p < .0001), and longer median duration of antimicrobial therapy (29 versus 12 days, p < .0001) and median length of hospital stay (17 versus 11 days, p < .0001).
This real-life study revealed remarkable differences in the management of cSSSI between the two Nordic cities. Compared to mainly Infectious Disease Specialist guided treatment in Gothenburg, the more frequent transfer from one ward to another in Helsinki was linked to longer antimicrobial therapy and hospital stay and to more frequent changes in antimicrobial treatment.
在具有相似医疗结构且抗菌药物耐药率较低的两个地区，对比了复杂性皮肤和皮肤结构感染（cSSSI）的管理实践。
北欧国家对公共医疗保健的高度重视使得本回顾性研究能够采用基于人群的方法。该研究人群（n=460）包括 2008 年至 2011 年期间因 cSSSI 在医院接受治疗的所有赫尔辛基（芬兰）和哥德堡（瑞典）的成年居民。
在住院期间，赫尔辛基的大多数患者（57%）去过一个以上病房，而在哥德堡，大多数患者（85%）仅在一个病房接受治疗。两个城市的患者背景和疾病特征基本相似，但赫尔辛基的患者更年轻[平均（标准差）59（18）岁与 63（19）岁，p=0.0117]，糖尿病（50%与 32%，p<0.0001）和混合感染（34%与 13%，p<0.0001）的比例更高。与哥德堡（47%，p<0.0001）相比，赫尔辛基患者更频繁地接受具有革兰氏阴性覆盖的抗菌药物（初始治疗中为 96%），治疗调整更多（每位患者平均使用抗菌药物 4.3 种与 2.7 种，p<0.0001），抗菌药物治疗的中位持续时间更长（29 天与 12 天，p<0.0001）和中位住院时间（17 天与 11 天，p<0.0001）。
这项真实世界的研究揭示了两个北欧城市在 cSSSI 管理方面的显著差异。与主要由传染病专家指导的哥德堡治疗相比，赫尔辛基更频繁地从一个病房转到另一个病房，与更长的抗菌药物治疗和住院时间以及更频繁的抗菌药物治疗改变有关。
