Development of a Risk-Scoring Tool to Determine Appropriate Level of Care in Acute Bacterial Skin and Skin Structure Infections in an Acute Healthcare Setting

Claeys, Kimberly C; Zasowski, Evan J; Lagnf, Abdalhamid M; Sabagha, Noor; Davis, Susan L.; Rybak, Michael J.

doi:10.1007/s40121-018-0212-3

Cited by 2 publications

(1 citation statement)

References 26 publications

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“…Both over-and under-treatment often represent inadequate adherence to published guidelines [9,10]. This may reflect the lack of a broadly accepted and widely used severity classification system for SSTIs and controversies regarding criteria for hospitalisation and the use of broad-spectrum antibiotics [7,11,12]. The IDSA guidelines and the UK CREST guidelines both give recommendations based on severity, but at the same time these documents lack clearly defined severity criteria [13,14].…”

Section: Introductionmentioning

confidence: 99%

Non-purulent skin and soft tissue infections: predictive power of a severity score and the appropriateness of treatment in a prospective cohort

Rath

Skrede

Oppegaard

et al. 2020

Infectious Diseases

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Background: Skin and soft tissue infections (SSTIs) are increasing. Frequent over-and under-treatment has been reported, including non-purulent SSTIs where cases demanding surgery or broad-spectrum therapy often are hard to identify. Our aim was to measure the predictive power of a modified severity score and use it to identify areas of improvement in antimicrobial therapy of non-purulent SSTIs. Methods: We prospectively included adult patients admitted to hospital with non-purulent SSTIs. A modified Dundee score at admission was calculated retrospectively, and associations between severity and outcomes were analysed. We evaluated appropriateness of treatment in relation to severity scores, and assessed adverse effects of broad-spectrum therapy. Results: We included 200 cases with cellulitis and 19 cases with necrotising soft tissue infections (NSTIs). Thirty-two per cent were categorised as severity class I, 15% as class II, 28% as class III and 25% as class IV (most severe). In class I, 66 out of 69 cases did not have a complicated course. All but one NSTI case were identified by the class IV criteria. Over-treatment was common and mostly seen in class I. Broad-spectrum antibiotics or clindamycin use was associated with an increased risk of diarrhoea. Prolonged treatment (>14 days) was associated with age, severity and surgery. Conclusions: The modified Dundee score proved valuable in identifying those with the lowest risk of complication and the most severe infections, and could serve as a useful clinical tool in the emergency department. Frequent over-treatment and associated adverse effects were confirmed, underscoring the need for improved risk assessment.

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