Skin and soft-tissue infections: Factors associated with mortality and re-admissions / Infecciones de piel y partes blandas: factores asociados a mortalidad y reingreso

INTRODUCTION: Skin and soft-tissue infections (SSTIs) are common and are linked to a wide variety of clinical conditions. Few studies have analysed the factors associated with mortality and re-admissions in medical patients with SSTIs. Accordingly, this study sought to describe the clinical and microbiological characteristics of patients diagnosed with SSTIs, and identify mortality and re-admission related factors. PATIENTS AND METHODS: A total of 308 patients were included in the study. Clinical, socio-demographic and microbiological characteristics were collected. Univariate and logistic regression multivariate analyses were performed in order to identify factors associated with mortality and re-admission. RESULTS: The bacteria responsible were identified in 95 (30.8%) patients, with gram-positive bacteria being isolated in 67.4% and gram-negative in 55.8% of cases. Multi-resistant bacteria were frequent (39%), and the initial empirical treatment proved inadequate in 25.3% of all cases. In-hospital mortality was 14.9%; the related variables were heart failure (OR=5.96; 95%CI: 1.93-18.47), chronic renal disease (OR=6.04; 95%CI: 1.80-20.22), necrotic infection (OR=4.33; 95%CI: 1.26-14.95), and inadequate empirical treatment (OR=44.74; 95%CI: 5.40-370.73). Six-month mortality was 8%, with the main related factors being chronic renal disease (OR: 3.03; 95%CI: 1.06-8.66), and a Barthel Index score of under 20 (OR: 3.62; 95%CI: 1.17-11.21). Re-admission was necessary in 26.3% of cases, with the readmission-related variables being male gender (OR: 2.12; 95%CI: 1.14-3.94), peripheral vascular disease (OR: 3.05; 95%CI: 1.25-7.41), and an age-adjusted Charlson Comorbidity Index score of over 3 (OR: 3.27; 95%CI: 1.40-7.63). CONCLUSIONS: Clinical variables such as heart failure, chronic renal disease, peripheral vascular disease, and necrotic infection could help identify high-risk patients. The main factor associated with higher mortality was inadequate initial empirical treatment. Physicians should consider gram-negative, and even extended-spectrum beta-lactamase-producing bacteria when assigning initial empirical treatment for SSTIs, especially in healthcare-associated cases

INTRODUCCIÓN: Las infecciones de piel y partes blandas (IPPB) son frecuentes y se asocian a una amplia variedad de presentaciones clínicas. Los factores asociados a mortalidad y reingreso en pacientes con IPPB han sido poco estudiados hasta ahora. En este sentido, el objetivo del presente trabajo es describir las características clínicas y microbiológicas de pacientes diagnosticados de IPPB e identificar factores asociados a mortalidad y reingreso en ellos. PACIENTES Y MÉTODOS: Fueron incluidos un total de 308 pacientes. Se realizó una descripción de las características clínicas, sociodemográficas y microbiológicas. Se llevaron a cabo análisis uni y multivariantes de regresión logística para identificar factores asociados a mortalidad y reingreso en pacientes con IPPB. RESULTADOS: Los microorganismos responsables fueron identificados en 95 (30,8%) pacientes, de ellos el 67,4% presentaban bacterias grampositivas y el 55,8%, gramnegativas. La presencia de bacterias multirresistentes fue frecuente (39%) y el tratamiento empírico fue inadecuado en el 25,3% de los casos. La mortalidad intrahospitalaria fue del 14,9% y las variables asociadas a ella fueron la insuficiencia cardiaca (OR=5,96; IC95%: 1,93-18,47), la insuficiencia renal crónica (OR=6,04; IC95%: 1,80-20,22), la infección necrótica (OR=4,33; IC95%: 1,26-14,95) y el tratamiento antibiótico empírico inadecuado (OR=44,74; IC95%: 5,40-370,73). La mortalidad a 6 meses fue del 8%, y los principales factores asociados, la insuficiencia renal crónica (OR=3,03; IC95%: 1,06-8,66) y una puntuación en el índice de Barthel inferior a 20 puntos (OR=3,62; IC95%: 1,17-11,21). Reingresaron durante el seguimiento a 6meses el 26,3% de los pacientes; las variables asociadas a este hecho fueron el sexo masculino (OR=2,12; IC95%: 1,14-3,94), la enfermedad vascular periférica (OR=3,05; IC95%: 1,25-7,41) y una puntuación en el índice de Charlson ajustado por edad superior a 3puntos (OR=3,27; IC95%: 1,40-7,63). CONCLUSIONES: Variables clínicas como la insuficiencia cardiaca, la insuficiencia renal crónica, la enfermedad vascular periférica y la infección necrótica podrían ayudar a identificar pacientes con IPPB de alto riesgo. El principal factor asociado a una mayor mortalidad fue el tratamiento antibiótico empírico inadecuado. Debería considerarse la posibilidad de que bacterias gramnegativas, o incluso enterobacterias productoras de betalactamasas de espectro extendido, sean las responsables de IPPB, sobre todo en casos asociados a los cuidados sanitarios, a la hora de plantear el tratamiento antibiótico empírico en estos pacientes

Skin and soft-tissue infections: Factors associated with mortality and re-admissions.

INTRODUCTION: Skin and soft-tissue infections (SSTIs) are common and are linked to a wide variety of clinical conditions. Few studies have analysed the factors associated with mortality and re-admissions in medical patients with SSTIs. Accordingly, this study sought to describe the clinical and microbiological characteristics of patients diagnosed with SSTIs, and identify mortality and re-admission related factors. PATIENTS AND METHODS: A total of 308 patients were included in the study. Clinical, socio-demographic and microbiological characteristics were collected. Univariate and logistic regression multivariate analyses were performed in order to identify factors associated with mortality and re-admission. RESULTS: The bacteria responsible were identified in 95 (30.8%) patients, with gram-positive bacteria being isolated in 67.4% and gram-negative in 55.8% of cases. Multi-resistant bacteria were frequent (39%), and the initial empirical treatment proved inadequate in 25.3% of all cases. In-hospital mortality was 14.9%; the related variables were heart failure (OR=5.96; 95%CI: 1.93-18.47), chronic renal disease (OR=6.04; 95%CI: 1.80-20.22), necrotic infection (OR=4.33; 95%CI: 1.26-14.95), and inadequate empirical treatment (OR=44.74; 95%CI: 5.40-370.73). Six-month mortality was 8%, with the main related factors being chronic renal disease (OR: 3.03; 95%CI: 1.06-8.66), and a Barthel Index score of under 20 (OR: 3.62; 95%CI: 1.17-11.21). Re-admission was necessary in 26.3% of cases, with the readmission-related variables being male gender (OR: 2.12; 95%CI: 1.14-3.94), peripheral vascular disease (OR: 3.05; 95%CI: 1.25-7.41), and an age-adjusted Charlson Comorbidity Index score of over 3 (OR: 3.27; 95%CI: 1.40-7.63). CONCLUSIONS: Clinical variables such as heart failure, chronic renal disease, peripheral vascular disease, and necrotic infection could help identify high-risk patients. The main factor associated with higher mortality was inadequate initial empirical treatment. Physicians should consider gram-negative, and even extended-spectrum beta-lactamase-producing bacteria when assigning initial empirical treatment for SSTIs, especially in healthcare-associated cases.

Piomiositis por Escherichia coli en un paciente en tratamiento crónico con glucocorticoides / Pyomiositis caused by Escherichia coli in a patient on chronic glucocorticoid treatment

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