381. Impact of Positive Blood Cultures on the Economic Outcomes of Patients with Complicated Skin and Skin Structure Infections: Focus on Gram-Positive Infections
Session: Poster Abstract Session: Epidemiology - Bacterial Infections
Friday, October 21, 2011
Room: Poster Hall B1
Background: Skin and skin structure infections (SSSIs) have traditionally been viewed as having a lower risk of mortality, morbidity, and costs compared to other types of infection including pneumonia, bloodstream, and intra-abdominal. The influence of secondary bacteremia on the medico-economic outcomes of patients with SSSIs has not been well described.

Methods: Retrospective cohort study involving 579 patients with culture-positive SSSIs admitted between April 1, 2005 and December 31, 2007. The outcomes evaluated in this analysis included hospital mortality, length of stay, hospital costs, and hospital readmission.

Results: Secondary bacteremia was present in 277 (47.8%) patients. Hospital mortality was statistically greater among patients with bacteremia (7.9% vs. 1.0%; p < 0.001). The unadjusted median length of stay in bacteremic patients was 7.1 days compared to 2.8 days in those without bacteremia (p < 0.001 by log-rank test). This correlated with total hospital costs that were greater in patients with bacteremia (median values: $14,623 vs. $5,841.5; p < 0.001). In a Cox model controlling for multiple confounders, bacteremia independently correlated with continued hospitalization (adjusted hazard ratio 1.960, 95% confidence interval 1.790 – 2.147, p < 0.001). Hospital readmission within thirty days of discharge was also significantly more common among patients with SSSIs complicated by bacteremia (24.5% vs. 12.9%; p < 0.001).

Conclusion: Bacteremia complicating SSSIs occurred in almost one-half of patients infected with Gram-positive bacteria in our institution. Beyond its impact on mortality, bacteremia is associated with increased length of stay, hospital costs, and readmission.

Funding: Barnes-Jewish Hospital foundation and Cubist Pharmaceuticals.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Scott Micek, PharmD, Pharmacy, Barnes-Jewish Hospital, St. Louis, MO, Alex Hoban, Barnes-Jewish Hospital, St. Louis, MO, Joshua A Doherty, BS, BJC Healthcare, St. Louis, MO and Marin Kollef, MD, Washington University School of Medicine, St. Louis, MO; Barnes Jewish Hospital

Disclosures:

S. Micek, Cubist Pharmaceuticals: Grant Investigator, Grant recipient, Research grant and Research support

A. Hoban, None

J. A. Doherty, None

M. Kollef, Cubist: Research Contractor, Grant recipient, Research grant and Research support

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.