Infecciones de piel y partes blandas en pacientes hospitalizados: factores epidemiológicos, microbiológicos, clínicos y pronósticos / Skin and soft-tissue infections in hospitalized patients: Epidemiology, microbiological, clinical and prognostic factors

INTRODUCCIÓN: Las infecciones de piel y partes blandas (IPPB) son un motivo de consulta bastante frecuente en los servicios hospitalarios, y los casos que se complican requieren hospitalización. Sin embargo, hay escasos estudios en nuestro ámbito en los que se describan estas infecciones. Material y métodos Estudio observacional retrospectivo de los episodios con diagnóstico de foliculitis, celulitis, erisipela, abscesos, hidrosadenitis, forúnculo, impétigo, fascitis, mionecrosis y gangrena de Fournier extraídos de la base de datos de codificación diagnóstica del Servicio de Archivos y Documentación Clínica del Hospital Son Llàtzer desde enero de 2002 a noviembre de 2011.ResultadosSe estudiaron 996 episodios en 841 pacientes hospitalizados con algún diagnóstico de IPPB. La entidad diagnosticada con mayor frecuencia fue la celulitis/erisipela (66,7%); el origen de la IPPB era comunitario (77%) y la mayoría de pacientes presentaban comorbilidades, sobre todo diabetes (33%) e insuficiencia cardiaca (17,7%). El microrganismo aislado más frecuentemente fue S.aureus (35,1%), presentaban resistencia a la meticilina (SARM) 19 casos (12,9%), siendo la mayoría de los casos resistentes a SARM (84,2%) de origen nosocomial o asociado a cuidados. El tratamiento empírico se realizó con más frecuencia en monoterapia con aminopenicilinas con inhibidores de betalactamasas (35,5%). Los nuevos fármacos para grampositivos (linezolid, daptomicina y tigeciclina) se utilizaron más frecuentemente en pacientes con comorbilidades que presentaron más complicaciones (p < 0,001) y mayor riesgo de mortalidad (p = 0,001). Durante el ingreso fallecieron el 10,9% de los pacientes, pero solamente en el 2,7% la mortalidad se relacionó con la IPPB. CONCLUSIONES: Las IPPB que se atienden con más frecuencia en pacientes hospitalizados son sobre todo celulitis/erisipela, la mayoría de ellas adquiridas en la comunidad. La infección por SARM se relaciona principalmente con la asistencia sanitaria. El uso de los nuevos antibióticos frente a grampositivos fue bastante limitado

INTRODUCTION: Skin and soft-tissue infections (SSTIs) are a frequent cause of consultation in emergence services, and complicated cases require hospitalization. However there are few data in our setting about the clinical characteristics of these infections. MATERIAL AND METHODS: A retrospective review of hospital admitted patients with a diagnosis of folliculitis, cellulitis, erysipelas, abscesses, hidradenitis, furuncle, impetigo, fasciitis and Fournier's gangrene. Cases were extracted from the data base of diagnostic codes of the Archive and Clinical Documentation Department of Son Llàtzer Hospital from January 2002 to November 2011.RESULTS: We studied 996 episodes in 841 hospitalized patients with any diagnosis of SSTIs. Cellulitis/erysipelas (66.7%) was the most frequently diagnosed condition, with 77% of all SSTIs being community acquired, and the majority of patients had comorbidities, mainly diabetes (33%) and heart failure(17.7%). The most frequent isolated microorganism was S.aureus (35.1%), in 19 (12.9%) cases with methicillin-resistance (MRSA), 84.2% of them were nosocomial or health care acquired. Monotherapywith aminopenicillin with clavulanic acid was the empiric treatment most frequently used (35.5%). Newantibiotics for Gram-positive cocci (linezolid, daptomycin, and tigecycline) were used in patients with comorbidities that presented more complications (P < .001) and more risk of mortality (P = .001). During admission 10.9% of patients died, but only in 2.7% of them mortality was related to the SSTIs. CONCLUSIONS: SSTIs attended most frequently in hospitalized patients are mainly cellulitis/erysipela, the majority community acquired. MRSA infections are mainly health care related. Use of new antibiotic for Gram-positive cocci was limited

[Skin and soft-tissue infections in hospitalized patients: epidemiology, microbiological, clinical and prognostic factors]. / Infecciones de piel y partes blandas en pacientes hospitalizados: factores epidemiológicos, microbiológicos, clínicos y pronósticos.

INTRODUCTION: Skin and soft-tissue infections (SSTIs) are a frequent cause of consultation in emergence services, and complicated cases require hospitalization. However there are few data in our setting about the clinical characteristics of these infections. MATERIAL AND METHODS: A retrospective review of hospital admitted patients with a diagnosis of folliculitis, cellulitis, erysipelas, abscesses, hidradenitis, furuncle, impetigo, fasciitis and Fournier's gangrene. Cases were extracted from the data base of diagnostic codes of the Archive and Clinical Documentation Department of Son Llàtzer Hospital from January 2002 to November 2011. RESULTS: We studied 996 episodes in 841 hospitalized patients with any diagnosis of SSTIs. Cellulitis/erysipelas (66.7%) was the most frequently diagnosed condition, with 77% of all SSTIs being community acquired, and the majority of patients had comorbidities, mainly diabetes (33%) and heart failure (17.7%). The most frequent isolated microorganism was S.aureus (35.1%), in 19 (12.9%) cases with methicillin-resistance (MRSA), 84.2% of them were nosocomial or health care acquired. Monotherapy with aminopenicillin with clavulanic acid was the empiric treatment most frequently used (35.5%). New antibiotics for Gram-positive cocci (linezolid, daptomycin, and tigecycline) were used in patients with comorbidities that presented more complications (P<.001) and more risk of mortality (P=.001). During admission 10.9% of patients died, but only in 2.7% of them mortality was related to the SSTIs. CONCLUSIONS: SSTIs attended most frequently in hospitalized patients are mainly cellulitis/erysipela, the majority community acquired. MRSA infections are mainly health care related. Use of new antibiotic for Gram-positive cocci was limited.