Methods: This was a retrospective, observational, multicenter study of adults with ABSSSI presenting to the ED between 7/01/12 - 6/30/13, identified by ICD-9 Codes: 681.XX, 682.XX, 686.XX, 958.3X, and 998.5X. Patient disposition (admitted vs. not admitted to hospital) was analyzed using univariate logistical regression (SAS, version 9.3).
Results: A total of 1541 patients were evaluable from 40 sites. Almost twice as many patients seen in the ED were treated as outpatients versus admitted for ABSSSI (950 vs. 592, respectively). Patient characteristics associated with admission vs outpatient treatment after ED visit, respectively, were: higher Charlson indices [OR(95% CI), 1.5(1.4-1.6)]; diabetes (34 vs 20%), [2.1 (1.7-2.6)] intravenous (IV) drug use history (13 vs 6%), [2.1(1.4-3.0)]; immunocompromised status (6 vs 2%), [3.5(2.0-6.0)]; past admission for ABSSSI (24 vs 11%), [2.5(1.9-3.4)]; having a previous hospital admission within 90 days (29 vs 10%), [3.5(2.7-4.6)]; prior antibiotic use within 90 days (41 vs 20%), [2.8(2.2-3.5)]; having a known history of MRSA (16 vs 8%), [2.1(1.5-2.8)]; initial SIRS criteria on presentation (33 vs 6%) [2.5(1.8-3.5)]. More patients admitted to the hospital had PICC lines inserted (17 vs 1%), [30.2(13.1-69.3)]. We also noted that up to 65% of patients did not have a documented follow up visit scheduled.
Conclusion: A number of patient characteristics were associated with the decision to hospitalize patients presenting to the ED with ABSSSI. Future study is needed to determine whether a subset of patients admitted to the hospital could be treated safely with oral or long-acting IV antibiotics exclusively as outpatients.
Actavis: Speaker's Bureau , Speaker honorarium
Merck: Speaker's Bureau , Speaker honorarium
A. Haynes, Actavis, Inc.: Employee and Shareholder , Salary
C. Lopes, Actavis, Inc.: Employee and Shareholder , Salary
H. Zhu, Actavis, Inc.: Employee and Shareholder , Salary
S. Goldwater, Actavis, Inc: Employee and Shareholder , Salary
R. Owens Jr., Actavis, Inc: Employee and Shareholder , Salary
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