Severity assessment of skin and soft tissue infections: cohort study of management and outcomes for hospitalized patients

Marwick, C., Broomhall, J., Mccowan, C. , Phillips, G., Gonzalez-McQuire, S., Akhras, K., Merchant, S., Nathwani, D. and Davey, P. (2011) Severity assessment of skin and soft tissue infections: cohort study of management and outcomes for hospitalized patients. Journal of Antimicrobial Chemotherapy, 66(2), pp. 387-97. (doi: 10.1093/jac/dkq362)

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Abstract

<p>Background Skin and soft tissue infections (SSTIs) are caused by bacterial invasion of the skin and underlying soft tissues and can present with a wide spectrum of signs, symptoms and illness severity. They are a common indication for antimicrobial therapy. However, there are few data on treatment outcomes or the validity of clinical severity scores.</p> <p>Methods Two hundred and five adult patients admitted to Ninewells Hospital, Scotland in 2005, and treated with antibiotics for SSTI, were identified. They were stratified into four classes of severity (class IV = most severe) based on sepsis, co-morbidity and their standardized early warning score (SEWS). Empirical antimicrobial therapy by severity class was compared with the recommendations of a UK guideline.</p> <p>Results Thirty-five different empirical antimicrobial regimens were prescribed. Overall, 43% of patients were over-treated, this being particularly common in the lowest severity class I (65% patients). Thirty-day mortality was 9% (18/205) and 17 patients (8%) died during their index admission. Mortality (30 day) and inadequate therapy increased with severity class: I, no sepsis or co-morbidity (45% patients, 1% mortality, 14% therapy inadequate); II, significant co-morbidity but no sepsis (32% patients, 11% mortality, 39% therapy inadequate); III, sepsis but SEWS <4 (17% of patients, 17% mortality, 39% therapy inadequate); and IV, sepsis plus SEWS ≥4 (6% of patients, 33% mortality, 92% therapy inadequate).</p> <p>Conclusions SSTI in hospital is associated with significant mortality. Choice of empirical therapy is not evidence based, with significant under-treatment of severely ill patients.</p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mccowan, Professor Colin
Authors: Marwick, C., Broomhall, J., Mccowan, C., Phillips, G., Gonzalez-McQuire, S., Akhras, K., Merchant, S., Nathwani, D., and Davey, P.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Journal of Antimicrobial Chemotherapy
Journal Abbr.:J. Antimicrob. Chemother.
ISSN:0305-7453
ISSN (Online):1460-2091
Published Online:05 October 2010

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