Internal Medicine and Infectious Diseases, Son Llàtzer Hospital, Balearic Islands, Spain.
Head of Internal Medicine and Infectious Diseases, Son Llàtzer Hospital, Balearic Islands, Spain.
Int J Dermatol. 2019 Aug;58(8):916-924. doi: 10.1111/ijd.14390. Epub 2019 Feb 15.
Skin and soft tissue infections (SSTIs) are a common cause of consultation, and complicated cases require hospitalization. We describe factors that are related to readmission and/or mortality of hospitalized patients diagnosed with SSTIs.
Retrospective review of hospital-admitted patients with a diagnosis of cellulitis, abscess, hidradenitis, fasciitis, and Fournier's gangrene. Cases from January 2002 to October 2015 were extracted from the diagnostic codification database of the Archives and Clinical Documentation Department.
We studied 1,482 episodes of hospitalized patients diagnosed with SSTIs. There were 187 (12.3%) readmissions, the most frequent diagnosis was cellulitis (72.7%), and the most commonly isolated microorganism was Staphylococcus aureus (25; 30.1%). Factors associated with readmissions were healthcare-related infections (P = 0.002), prior antibiotic therapy (P < 0.001), ischemic heart disease (P = 0.01), chronic liver disease (P = 0.001), and diabetes mellitus (DM) (P = 0.006). The number of patients who died as a result of an infection was 34 (2.2%) and, in these patients, the most common diagnosis was also cellulitis (79.4%), which in 52.9% (P = 0.001) was community acquired. DM (P = 0.01), heart failure (P = 0.001), and chronic liver disease (P = 0.003) were the most frequent comorbidities. This group presented more complications (P < 0.005) such as endocarditis (P < 0.005), amputation (P = 0.018), severe sepsis (P < 0.005), and septic shock (P < 0.001).
Readmitted patients had healthcare-related S. aureus infection, had received prior antibiotic therapy, and presented comorbid conditions such as ischemic heart disease, peripheral vascular disease, chronic liver disease, or DM. Comorbidities such as advanced age, DM, heart failure, and chronic liver disease were associated with complications and higher infection-related mortality.
皮肤和软组织感染（SSTIs）是常见的就诊原因，复杂的病例需要住院治疗。我们描述了与住院 SSTIs 患者再入院和/或死亡相关的因素。
回顾性分析 2002 年 1 月至 2015 年 10 月期间在医院诊断为蜂窝织炎、脓肿、化脓性汗腺炎、筋膜炎和 Fournier 坏疽的住院患者。从档案和临床文档部门的诊断编码数据库中提取病例。
我们研究了 1482 例住院 SSTIs 患者。有 187 例（12.3%）再入院，最常见的诊断是蜂窝织炎（72.7%），最常见的分离微生物是金黄色葡萄球菌（25；30.1%）。与再入院相关的因素包括医疗保健相关感染（P=0.002）、先前的抗生素治疗（P<0.001）、缺血性心脏病（P=0.01）、慢性肝病（P=0.001）和糖尿病（DM）（P=0.006）。因感染而死亡的患者有 34 例（2.2%），这些患者最常见的诊断也是蜂窝织炎（79.4%），其中 52.9%（P=0.001）为社区获得性。DM（P=0.01）、心力衰竭（P=0.001）和慢性肝病（P=0.003）是最常见的合并症。该组出现更多并发症（P<0.005），如心内膜炎（P<0.005）、截肢（P=0.018）、严重败血症（P<0.005）和感染性休克（P<0.001）。
再入院患者发生了医疗保健相关的金黄色葡萄球菌感染，接受了先前的抗生素治疗，并有缺血性心脏病、外周血管疾病、慢性肝病或 DM 等合并症。年龄较大、DM、心力衰竭和慢性肝病等合并症与并发症和更高的感染相关死亡率相关。
