Recurrent Skin and Soft Tissue Infections in Emergency Department Patients in California, 2005-2011

Background:

More than 2 million visits for skin and soft tissue infections (SSTIs) are seen in US emergency departments (ED) yearly. Previous studies suggest up to 50% of patients with purulent SSTI suffer from recurrences. Our objective was to describe rates and predictors of recurrent SSTIs.

Methods:

Retrospective study of patients with primary diagnosis of SSTI who visited an ED between 2005 and 2011 using California ED discharge data from the State Emergency Department Databases (SEDD) and State Inpatient Databases (SID). We used multivariable logistic regression to investigate the association between socio-demographic factors and comorbidities with a repeat ED visit for an SSTI 2 weeks–6 months after an initial visit. We used a proportional trend analysis to evaluate recurrence rates over the study period.

Results:

Of 253,371 SSTIs, 15.4% had a recurrent visit. Race/ethnicity, age, geographic location, household income, and comorbidities were all associated with recurrent visits. We found no trend in recurrent visits over time (χ²=2.13, p=0.15). Patients hospitalized after their ED visit had lower recurrent visit rates compared to discharged patients (OR 0.35 [95% CI 0.34-0.36], p<0.01). Higher recurrent visit rates were found in patients with drug/alcohol abuse or liver disease (OR 1.35 [95% CI 1.32-1.39], p<0.01), obesity (OR 1.30 [95% CI 1.24-1.36], p<0.01), and in infections that were drained or aspirated (OR=1.10 [95% CI 1.07-1.13], p<0.01).

Conclusion:

In this investigation utilizing very large administrative datasets to investigate recurrent SSTIs, we found several patient-level factors associated with recurrence. Identification of these high-risk groups is critical for future ED based interventions to minimize recidivism of this very common infection.