Hospitalizations with healthcare-associated complicated skin and skin structure infections: Impact of inappropriate empiric therapy on outcomes

Objective.Healthcare-associated infections are likely to be caused by drug-resistant and possibly mixed organisms and to be treated with inappropriate antibiotics. Because prompt appropriate treatment is associated with better outcomes, we studied the epidemiology of healthcare-associated complicated skin and skin-structure infections (cSSSIs).Patients.Persons hospitalized with cSSSI and a positive culture result.Methods.We conducted a single-center retrospective cohort study from April 2006 through December 2007. We differentiated healthcare-associated from community-acquired cSSSIs by at least 1 of the following risk factors: (1) recent hospitalization, (2) recent antibiotics, (3) hemodialysis, and (4) transfer from a nursing home. Inappropriate treatment was defined as no antimicrobial therapy with activity against the offending pathogen(s) within 24 hours after collection of a culture specimen. Mixed infections were those caused by both a gram-positive and a gram-negative organism.Results.Among 717 hospitalized patients with cSSSI, 527 (73.5%) had healthcare-associated cSSSI. Gram-negative organisms were more common (relative risk, 1.24 [95% confidence interval, 1.14–1.35) and inappropriate treatment trended toward being more common (odds ratio, 1.29 [95% confidence interval, 0.85–1.95]) in healthcare-associated cSSSI than in community-acquired cSSSI. Mixed cSSSIs occurred in 10.6% of patients with healthcare-associated cSSSI and 6.3% of those with community-acquired cSSSI (P = .082) and were more likely to be treated inappropriately than to be nonmixed infections (odds ratio, 2.42 [95% confidence interval, 1.43–4.10]). Both median length of hospital stay (6.2 vs 2.9 days; P < .001) and mortality rate (6.6% vs 1.1%; P = .003) were significantly higher for healthcare-associated cSSSI than community-acquired cSSSI.Conclusions.Healthcare-associated cSSSIs are common and are likely to be caused by gram-negative organisms. Mixed infections carry a <2-fold greater risk of inappropriate treatment. Healthcare-associated cSSSIs are associated with increased mortality and prolonged length of hospital stay, compared with community-acquired cSSSIs.

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Risk Factors for Mixed Complicated Skin and Skin Structure Infections To Help Tailor Appropriate Empiric Therapy

Surgical Infections ◽

10.1089/sur.2011.101 ◽

2012 ◽

Vol 13 (6) ◽

pp. 377-382 ◽

Cited By ~ 9

Author(s):

Marya Zilberberg ◽

Scott T. Micek ◽

Marin H. Kollef ◽

Ahmed Shelbaya ◽

Andrew F. Shorr

Keyword(s):

Risk Factors ◽

Empiric Therapy ◽

Skin Structure ◽

Complicated Skin

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Assessing Outcomes With Ceftaroline Treatment Compared with Standard of Care among Hospitalized Patients With Complicated Skin And Skin-Structure Infections (Csssi)

Value in Health ◽

10.1016/j.jval.2015.03.1335 ◽

2015 ◽

Vol 18 (3) ◽

pp. A229-A230

Author(s):

S. Karve ◽

J. Hackett ◽

J. Levinson

Keyword(s):

Standard Of Care ◽

Hospitalized Patients ◽

Skin Structure ◽

Complicated Skin

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Comparison of Prospective and Retrospective Methods of a Tigecycline Post-Marketing Surveillance Study in the Safety Outcomes of Patients with Complicated Skin Structure Infection, Complicated Intraabdominal Infection and Community-Acquired Pneumonia

Infectious Diseases and Therapy ◽

10.1007/s40121-021-00398-7 ◽

2021 ◽

Author(s):

Whanhui Chi ◽

Hye Jung Lee ◽

Yong Pil Chong

Keyword(s):

Community Acquired Pneumonia ◽

Intraabdominal Infection ◽

Surveillance Study ◽

Skin Structure Infection ◽

Skin Structure ◽

Structure Infection ◽

Post Marketing Surveillance ◽

Complicated Skin ◽

Safety Outcomes ◽

Post Marketing

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Telavancin for Acute Bacterial Skin and Skin Structure Infections, aPost HocAnalysis of the Phase 3 ATLAS Trials in Light of the 2013 FDA Guidance

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00471-15 ◽

2015 ◽

Vol 59 (10) ◽

pp. 6170-6174 ◽

Cited By ~ 5

Author(s):

Richard Pushkin ◽

Steven L. Barriere ◽

Whedy Wang ◽

G. Ralph Corey ◽

Martin E. Stryjewski

Keyword(s):

Clinical Response ◽

Lesion Size ◽

Phase 3 ◽

Two Phase ◽

Skin Structure ◽

Fda Guidance ◽

Complicated Skin ◽

Clinical Responses ◽

Cure Rates ◽

Post Hoc

ABSTRACTTwo phase 3 ATLAS trials demonstrated noninferiority of telavancin compared with vancomycin for complicated skin and skin structure infections. Data from these trials were retrospectively evaluated according to 2013 U.S. Food and Drug Administration (FDA) guidance on acute bacterial skin and skin structure infections. Thispost hocanalysis included patients with lesion sizes of ≥75 cm2and excluded patients with ulcers or burns (updated all-treated population;n= 1,127). Updated day 3 (early) clinical response was defined as a ≥20% reduction in lesion size from baseline and no rescue antibiotic. Updated test-of-cure (TOC) clinical response was defined as a ≥90% reduction in lesion size, no increase in lesion size since day 3, and no requirement for additional antibiotics or significant surgical procedures. Day 3 (early) clinical responses were achieved in 62.6% and 61.0% of patients receiving telavancin and vancomycin, respectively (difference, 1.7%, with a 95% confidence interval [CI] of −4.0% to 7.4%). Updated TOC visit cure rates were similar for telavancin (68.0%) and vancomycin (63.3%), with a difference of 4.8% (95% CI, −0.7% to 10.3%). Adopting current FDA guidance, this analysis corroborates previous noninferiority findings of the ATLAS trials of telavancin compared with vancomycin.

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