1536. Patient Factors That Influence the Decision to Admit or Discharge Patients with Acute Bacterial Skin and Skin Structure Infections (ABSSSIs)
Session: Poster Abstract Session: Clinical Infectious Diseases: Soft Tissue Infections (ABSSSIs)
Saturday, October 10, 2015
Room: Poster Hall
  • Patient Factors_IDWeek_FINAL 10.08.15.pdf (125.2 kB)
  • Background: ABSSSIs have resulted in increased hospital admissions over the last decade. It is likely that some admitted patients could be treated as outpatients, potentially reducing hospital complications, use of healthcare resources and increasing patient satisfaction. The objective of this study was to evaluate patient factors that influence the decision to admit ABSSSI patients presenting to the emergency department (ED).

    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.

    Shira Doron, MD, MS1, Timothy Jenkins, MD2, Angela Haynes, PharmD, MBA3, Carlos Lopes, PharmD4, Haiyuan Zhu, PhD4, Shannon Goldwater, PharmD, BCPS, FASHP3 and Robert Owens Jr., PharmD5, (1)Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, (2)Medicine/Infectious Diseases, University of Colorado-Denver Health Sciences Center, Denver, CO, (3)Heor, Actavis, Inc, Parsippany, NJ, (4)Medical Affairs, Actavis, Inc., Parsippany, NJ, (5)Medical Affairs, Actavis, Inc., Parippany, NJ


    S. Doron, Cubist: Speaker's Bureau , Speaker honorarium
    Actavis: Speaker's Bureau , Speaker honorarium
    Merck: Speaker's Bureau , Speaker honorarium

    T. Jenkins, Actavis, Inc: Scientific Advisor , Consulting fee

    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

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.