Factors associated with time to clinical stability in complicated skin and skin structure infections

Factors associated with the time to clinical stability in patients with complicated skin and skin structure infection (cSSSI) were analysed in a retrospective population-based study.

All hospitalized patients (n=402) with cSSSI in two Nordic cities during a 4-year period were included. Patient, disease, and treatment related factors were analysed in relation to early (0-3 days) or late (≥4 days) clinical stability. Clinical stability was assessed as improvement of infection related local and systemic signs. Furthermore, the effect of antimicrobial and other treatment on achievement of clinical stability was studied.

Clinical stability was reached within 0-3 days by 59% (239/402) of patients. In multivariable analysis later clinical stability was associated with admission to ICU (OR 10.1, 95% CI 4.01-25.3), posttraumatic wound infection (OR 3.17, 95% CI 1.31-7.69), bacteraemia (OR 3.09, 95% CI 1.36-7.02), surgical intervention after diagnosis (OR 2.64, 95% CI 1.36-5.11), diabetes (OR 2.33, 95% CI 1.28-4.25), and initial broad-spectrum antibiotic therapy (OR 3.03, 95% CI 1.43-6.40). Early stabilization within 3 days was associated with previous hospitalization (OR 0.47, 95% CI 0.22-0.99) and empirical antimicrobial therapy covering the initial pathogens (OR 0.38, 95% CI 0.18-0.80). Patients with clinical stability within 3 days were less likely to have treatment modifications and antimicrobial changes and had shorter hospital stay and antimicrobial treatment than those who stabilized later.

This study suggests that late treatment response depends on several baseline characteristics of patients and disease related factors other than treatment related factors.