Department of Medicine, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Science, University of Bergen, Bergen, Norway.
Infect Dis (Lond). 2020 May;52(5):361-371. doi: 10.1080/23744235.2020.1726447. Epub 2020 Feb 13.
Skin and soft tissue infections (SSTIs) are increasing. Frequent over- and under-treatment has been reported, including non-purulent SSTIs where cases demanding surgery or broad-spectrum therapy often are hard to identify. Our aim was to measure the predictive power of a modified severity score and use it to identify areas of improvement in antimicrobial therapy of non-purulent SSTIs. We prospectively included adult patients admitted to hospital with non-purulent SSTIs. A modified Dundee score at admission was calculated retrospectively, and associations between severity and outcomes were analysed. We evaluated appropriateness of treatment in relation to severity scores, and assessed adverse effects of broad-spectrum therapy. We included 200 cases with cellulitis and 19 cases with necrotising soft tissue infections (NSTIs). Thirty-two per cent were categorised as severity class I, 15% as class II, 28% as class III and 25% as class IV (most severe). In class I, 66 out of 69 cases did not have a complicated course. All but one NSTI case were identified by the class IV criteria. Over-treatment was common and mostly seen in class I. Broad-spectrum antibiotics or clindamycin use was associated with an increased risk of diarrhoea. Prolonged treatment (>14 days) was associated with age, severity and surgery. The modified Dundee score proved valuable in identifying those with the lowest risk of complication and the most severe infections, and could serve as a useful clinical tool in the emergency department. Frequent over-treatment and associated adverse effects were confirmed, underscoring the need for improved risk assessment.
皮肤和软组织感染（SSTIs）正在增加。据报道，经常出现过度和治疗不足的情况，包括非脓性 SSTIs，其中需要手术或广谱治疗的病例往往难以识别。我们的目的是测量改良严重程度评分的预测能力，并利用它来确定非脓性 SSTIs 抗菌治疗的改进领域。我们前瞻性地纳入了因非脓性 SSTIs 住院的成年患者。回顾性计算入院时改良的邓迪评分，并分析严重程度与结局之间的关系。我们评估了治疗与严重程度评分的适宜性，并评估了广谱治疗的不良反应。我们纳入了 200 例蜂窝织炎和 19 例坏死性软组织感染（NSTIs）患者。32%被归类为严重程度 I 级，15%为 II 级，28%为 III 级，25%为 IV 级（最严重）。在 I 级中，69 例中有 66 例没有复杂的病程。除了 1 例 NSTI 病例外，所有病例均符合 IV 级标准。过度治疗很常见，主要见于 I 级。广谱抗生素或克林霉素的使用与腹泻风险增加相关。延长治疗（>14 天）与年龄、严重程度和手术有关。改良的邓迪评分在识别并发症风险最低和感染最严重的患者方面非常有用，可作为急诊科有用的临床工具。证实了过度治疗和相关不良反应的频繁发生，这突出表明需要改进风险评估。
