1537. Factors Driving Emergency Department Revisits or Hospitalization Within 30 Days Post-Discharge (DC) in Patients with Acute Bacterial Skin and Skin Structure Infections (ABSSSI)
Session: Poster Abstract Session: Clinical Infectious Diseases: Soft Tissue Infections (ABSSSIs)
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Patient Outcomes_IDWeek_FINAL.pdf (423.5 kB)
  • Background: ABSSSI is a major contributor to antibiotic use.  While most patients (PTs) with ABSSSI present to the Emergency Department (ED) and are discharged on oral antibiotics, little is known about the frequency that patients with ABSSSI return to the ED or hospital (H) within 30 days post initial episode of care (IEC).  Our primary objective was to quantify the frequency and identify risk factors (RF) for patients with ABSSSI that return to the ED and/or H within 30 days post IEC.

    Methods: This was a retrospective, observational, multicenter study of adult ABSSSI patients presenting to EDs between 7/01/12 - 6/30/13. PTs were identified by ICD-9 Codes:  681.XX, 682.XX, 686.XX, 958.3X, and 998.5X. Facility, patient and clinical data were collected.  ABSSSI treatment failure (TF) was defined as an ED revisit and/or hospitalization within 30 days post IEC. RFs for TF were evaluated by univariate logistical regression (SAS, version 9.3).

    Results:

    1542 cases of ABSSSI from 40 centers were reviewed. A total of 451 patients (29%) had an ED revisit at least once within 30 days post IEC; patients admitted to H were less likely to have an ED revisit within 30 days post IEC [Odds Ratio 0.6 95% CI (0.4, 0.7)]. 132 (9%) patients were hospitalized within 30 days post IEC; patients previously admitted on IEC were more likely to be admitted to H within 30 days post IEC [3.9 (2.7, 5.7)]. Factors predicting ED revisit and hospitalization within 30 days post IEC are listed in the table.

     

    Factors Predicting ED Revisit and Hospitalization within 30 Days Post IEC [OR (95%CI)

    Patients ED Revisit

    Patients Hospitalization

    Incision & drainage when abscess present [1.8 95% CI (1.2, 2.8)]

    Infected devices [6.1 95% CI (2.0, 18.6)]

    Admitted at IEC [0.6 (0.4, 0.7)]

    Diabetic Foot Infection [4.3 (2.3, 8.2)]

    ACO [0.6 (0.4, 0.7)]

    Hospitalized within 90 days of IEC [3.9 (2.7, 5.7)]

    Dedicated Observation Unit [0.8 (0.6-1.0)]

    Implanted hardware [3.9 (2.3, 6.8)]

     

    Osteomyelitis [3.5 (1.5, 8.4)]

     

    PICC line [2.8 (1.6, 4.7)]

     

    History of MRSA [2.0 (1.3, 3.3)]

     

    Concurrent infection [1.9 (1.1, 3.3)]

     

    ACO [1.8 (1.0, 3.1)]

     

    Charlson Index [1.2 (1.2, 1.3)]

    Conclusion: This is the first study to document the frequency and risk factors of patients with ABSSSI that return for ED and/or H within 30 days post IEC.  Addressing risk factors provide opportunity to reduce the frequency of ED revisit and/or hospitalization in the 30 days post-DC from IEC thus improving patient care.

    Eddie Stenehjem, MD, MSc, Division of Infectious Disease, Intermountain Healthcare, Murray, UT, Jack Brown, PharmD, MS, BCPS, FCCP, Department of Pharmacy Practice and Adminiistration, Wegman's School of Pharmacy at St. Johns Fisher College of Pharmacy, Rochester, NY, Shannon Goldwater, PharmD, BCPS, FASHP, Heor, Actavis, Inc, Parsippany, NJ, Patrick Scoble, PharmD, Medical Affairs, Actavis, Inc., Parisippany, NJ and Robert Owens Jr., PharmD, Medical Affairs, Actavis, Inc., Parippany, NJ

    Disclosures:

    E. Stenehjem, Actavis, Inc.: Investigator and Scientific Advisor , Consulting fee and Research support

    J. Brown, Actavis, Inc.: Scientific Advisor , Consulting fee

    S. Goldwater, Actavis, Inc: Employee and Shareholder , Salary

    P. Scoble, 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.