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Original Research
Hospitalizations with healthcare-associated complicated skin and skin structure infections: Impact of inappropriate empiric therapy on outcomes†
Article first published online: 23 AUG 2010
DOI: 10.1002/jhm.713
Copyright © 2010 Society of Hospital Medicine
Additional Information
How to Cite
Zilberberg, M. D., Shorr, A. F., Micek, S. T., Chen, J., Ramsey, A. M., Hoban, A. P., Pham, V., Doherty, J. A., Mody, S. H. and Kollef, M. H. (2010), Hospitalizations with healthcare-associated complicated skin and skin structure infections: Impact of inappropriate empiric therapy on outcomes. J. Hosp. Med., 5: 535–540. doi: 10.1002/jhm.713
- †
Disclosure: Drs. Zilberberg, Shorr and Kollef have served as consultants to Ortho-McNeil Janssen Scientific Affairs, LLC, Raritan, NJ. Drs. Zilberberg and Mody and Ms. Chen are stockholders in Johnson & Johnson, the parent company of Ortho-McNeil Janssen Scientific Affairs, LLC. Dr. Mody and Ms. Chen are employees at Johnson & Johnson, the parent company of Ortho-McNeil Janssen Scientific Affairs, LLC. No parties other than the listed authors participated in drafting, revisions, copyediting or submission of the manuscript. Two of the authors (Dr. Mody and Ms. Chen) are employees of the study sponsor. Dr. Zilberberg had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Publication History
- Issue published online: 15 DEC 2010
- Article first published online: 23 AUG 2010
- Manuscript Accepted: 7 MAR 2010
- Manuscript Revised: 23 FEB 2010
- Manuscript Received: 18 JAN 2010
- Abstract
- Article
- References
- Cited By
Keywords:
- complicated skin and skin structure infections;
- healthcare-associated infections;
- empiric antibiotics;
- MRSA;
- antibiotic resistance;
- epidemiology;
- outcomes
Abstract
OBJECTIVE:
Inappropriate empiric therapy worsens outcomes in certain healthcare-associated infections (HCAI). We studied the association of inappropriate empiric therapy with outcomes in patients with HCA complicated skin and skin structure infections (cSSSI).
DESIGN:
A single-center retrospective cohort study.
PATIENTS:
Hospitalized with a culture-positive cSSSI.
MEASUREMENTS:
We defined HCA-cSSSI as having ≥1 of these risk factors: (1) recent hospitalization, (2) recent antibiotics, (3) hemodialysis, (4) transfer from a nursing home, and inappropriate treatment as no antimicrobial therapy active against the pathogen(s) within 24 hours of obtaining culture specimen. We performed descriptive and multivariate statistics to compute the impact of inappropriate empiric therapy on outcomes. Hospital length of stay (LOS) served as primary and mortality as secondary outcomes.
RESULTS:
Of the 717 patients with culture-positive cSSSI, 527 (73.5%) had HCAI, of whom 405 (76.9%) received appropriate treatment. A higher proportion of those receiving inappropriate than appropriate treatment had a decubitus ulcer (29.5% vs. 10.9%, P < 0.001), a device-associated infection (42.6% vs. 28.6%, P = 0.004), or bacteremia (68.9% vs. 57.8%, P = 0.028). The frequency of methicillin-resistant Staphylococcus aureus (MRSA) did not differ between the groups. The low overall unadjusted mortality rate did not vary based on initial treatment. In a multivariable analysis adjusting for potential confounders inappropriate therapy had an attributable increase in hospital LOS of 1.8 days (95% CI, 1.4–2.3).
CONCLUSION:
Similar to other populations with HCAI, HCA-cSSSI patients are likely to receive inappropriate empiric therapy for their infection. This early exposure is associated with a significant prolongation of the hospitalization by nearly 2 days. Journal of Hospital Medicine 2010;. © 2010 Society of Hospital Medicine.