Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Volc, S.
Describing complicated skin and soft tissue infections in a tertiary referral dermatological centre
[ Diplomarbeit ] Medical University of Graz; 2012. pp. 41
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Aberer Werner
- Brunasso Vernetti Alexandra Maria
- Altmetrics:
- Abstract:
- Background: Skin and soft tissue infections (SSTIs) are a group of infections localised in the skin and/or subcutaneous tissue and are among the most frequent infectious diseases in a dermatological emergency consultation setting. Although the mortality rate of SSTIs is low in general, the number of hospitalisations caused by them is rather high. They are responsible for quality of life reduction (QOL) in many of our patients and have a significant economical impact on the health care system. Materials and methods: We performed a retrospective study to evaluate the frequency and risk profiles of patients with SSTIs. Patient-data of 221 patients, treated in 2009 at the ward A of the Department of Dermatology and Venerology of the Medical University Hospital Graz, Austria, was obtained from the hospital information system Medocs and categorised with a standardised protocol. Results: 117 women and 104 men were included and the mean age was 61,2 years ± 18,1. Lower extremity SSTIs were the major site of infection, women showed a tendency towards facial infections, while men were more often afflicted at the upper extremities. The most common risk factors were obesity (34,8%), fungal foot infections (24,9%), diabetes mellitus (23,1%) and the most common comorbidities were arterial hypertension (31,2%) and chronic heart disease (9,9%). The only variables significantly associated with an increase in the days of admission were chronic lower extremity ulcers (mean increase of 7 days), bullous and/or haemorrhagic infections (mean increase of 5 days), thyroid diseases (mean increase of 5,5 days) and obesity (mean increase of 3,6 days). S.aureus was the most frequently isolated pathogen (39%). S.aureus and P.aeruginosa were the only detected multiresistant strains of bacteria. S.pyogenes was only detected in 4,9% of cases. The patients were stratified according to a modified version of the Eron classification into five classes of infection: 19,9% in class 1, 43,0% in class 2A, 19,0% in class 2B, 12,2% in class 3 and 3,6% in class 4. Infection class 1 patients were of younger age, but showed a tendency towards prolonged hospitalisation in comparison with other classes. The most frequent complications observed were antibiotic skin reactions in 7,2% and liver enzyme elevations (4,9%), sepsis was rarely seen. 20,8% of the patients relapsed and 16,3% presented with either a bullous or haemorrhagic form of SSTI. 2 patients (0,9%) died during their treatment. Conclusions: Our study shows a comprehensive summary of a big cohort of patients, their demographics and the treatment schedules. We attribute the, in comparison to other infection classes, prolonged hospitalisation of class 1 patients to the possible QOL-impairment resulting from infections of the hands, face or anogenital region. Obesity appeared to be the only significant risk factor for prolonged hospitalisation as well in the general cohort as in patients with recurrent episodes of SSTIs. The Eron classification proofed to be a very useful tool for efficient patient- stratification, which could be improved in the future by taking the site of infection into account of severity assessment. It is necessary to review SSTIs from a dermatological point of view, because, while internationally they are usually seen, treated and therefore scientifically discussed by non- dermatologists, in german speaking countries, these diseases are traditionally treated by dermatologists. Keywords: Complicated skin and soft tissue infections, SSTI, cellulitis, erysipela, stratification, risk factors