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451. High Rates of Hospitalization due to Skin and Soft-Tissue Infections in a Southwest American Indian Population

BACKGROUND: Skin and soft-tissue infections (SSTIs) involve the skin, subcutaneous tissue, fascia, or muscle. Hospitalizations due to SSTIs represent a significant health disparity for American Indians (AI), but specific literature is limited. We characterized SSTI hospitalizations at our critical a...

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Autores principales: Davidson, Anne M, Burgess, Terry, Saguros, Agafe, Jian Ma, Chu, McAuley, James, Close, Ryan M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808941/
http://dx.doi.org/10.1093/ofid/ofz360.524
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author Davidson, Anne M
Burgess, Terry
Saguros, Agafe
Jian Ma, Chu
McAuley, James
Close, Ryan M
author_facet Davidson, Anne M
Burgess, Terry
Saguros, Agafe
Jian Ma, Chu
McAuley, James
Close, Ryan M
author_sort Davidson, Anne M
collection PubMed
description BACKGROUND: Skin and soft-tissue infections (SSTIs) involve the skin, subcutaneous tissue, fascia, or muscle. Hospitalizations due to SSTIs represent a significant health disparity for American Indians (AI), but specific literature is limited. We characterized SSTI hospitalizations at our critical access hospital that exclusively serves an AI population in the American Southwest. METHODS: We identified patients hospitalized (admitted or transferred) with an SSTI from June 2017 to May 2018. Relevant cases underwent chart extraction for demographics, SSTI characteristics, laboratory and microbiologic data, relevant history and co-morbidities. All variables were summarized using descriptive statistics. Odds ratios and P-values with two-tailed tests were used to identify risk factors for multiple SSTI episodes. RESULTS: During the study period, 289 unique individuals comprised 343 SSTI hospitalizations / episodes (18% of the 1,883 total hospitalizations). The unadjusted annual rate of SSTI hospitalization was 2,018 per 100,000. There were 13 cases of necrotizing fasciitis (NF) with an unadjusted rate of 76 per 100,000 per year. Only 183 episodes (53%) had a wound culture performed, with 84% positive for a pathogenic organism, compared with 287 episodes (84%) with a blood culture performed, of which only 7% were positive for a pathogen. Methicillin-resistant Staphylococcus aureus (MRSA), methicillin-sensitive SA (MSSA)and/or Streptococcus pyogenes accounted for 74.9% (n = 125) and co-infection with these three organisms accounted for 22.2% (n = 37) of positive wound cultures (n = 167). An SSTI in the last year (49%), diabetes (41.9%), alcohol abuse (40%) and hypertension (39%) were common among all 289 individuals. Diabetes (OR 3.3, P < 0.01), hypertension (OR 2.8, P < 0.01), renal disease (OR 2.7, P < 0.05), previous SSTI (OR 3.0, P < 0.01) were associated with a higher risk of multiple SSTI hospitalizations. CONCLUSION: The incidence rate of SSTI hospitalization in this Southwest AI population was 9-times greater than the general US population and 4-times greater than prior reports in Southwest AI. The NF rate was >10-times the general US population rate. We describe common co-morbidities among these SSTI episodes and potential risk factors for repeat hospitalization. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68089412019-10-28 451. High Rates of Hospitalization due to Skin and Soft-Tissue Infections in a Southwest American Indian Population Davidson, Anne M Burgess, Terry Saguros, Agafe Jian Ma, Chu McAuley, James Close, Ryan M Open Forum Infect Dis Abstracts BACKGROUND: Skin and soft-tissue infections (SSTIs) involve the skin, subcutaneous tissue, fascia, or muscle. Hospitalizations due to SSTIs represent a significant health disparity for American Indians (AI), but specific literature is limited. We characterized SSTI hospitalizations at our critical access hospital that exclusively serves an AI population in the American Southwest. METHODS: We identified patients hospitalized (admitted or transferred) with an SSTI from June 2017 to May 2018. Relevant cases underwent chart extraction for demographics, SSTI characteristics, laboratory and microbiologic data, relevant history and co-morbidities. All variables were summarized using descriptive statistics. Odds ratios and P-values with two-tailed tests were used to identify risk factors for multiple SSTI episodes. RESULTS: During the study period, 289 unique individuals comprised 343 SSTI hospitalizations / episodes (18% of the 1,883 total hospitalizations). The unadjusted annual rate of SSTI hospitalization was 2,018 per 100,000. There were 13 cases of necrotizing fasciitis (NF) with an unadjusted rate of 76 per 100,000 per year. Only 183 episodes (53%) had a wound culture performed, with 84% positive for a pathogenic organism, compared with 287 episodes (84%) with a blood culture performed, of which only 7% were positive for a pathogen. Methicillin-resistant Staphylococcus aureus (MRSA), methicillin-sensitive SA (MSSA)and/or Streptococcus pyogenes accounted for 74.9% (n = 125) and co-infection with these three organisms accounted for 22.2% (n = 37) of positive wound cultures (n = 167). An SSTI in the last year (49%), diabetes (41.9%), alcohol abuse (40%) and hypertension (39%) were common among all 289 individuals. Diabetes (OR 3.3, P < 0.01), hypertension (OR 2.8, P < 0.01), renal disease (OR 2.7, P < 0.05), previous SSTI (OR 3.0, P < 0.01) were associated with a higher risk of multiple SSTI hospitalizations. CONCLUSION: The incidence rate of SSTI hospitalization in this Southwest AI population was 9-times greater than the general US population and 4-times greater than prior reports in Southwest AI. The NF rate was >10-times the general US population rate. We describe common co-morbidities among these SSTI episodes and potential risk factors for repeat hospitalization. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6808941/ http://dx.doi.org/10.1093/ofid/ofz360.524 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Davidson, Anne M
Burgess, Terry
Saguros, Agafe
Jian Ma, Chu
McAuley, James
Close, Ryan M
451. High Rates of Hospitalization due to Skin and Soft-Tissue Infections in a Southwest American Indian Population
title 451. High Rates of Hospitalization due to Skin and Soft-Tissue Infections in a Southwest American Indian Population
title_full 451. High Rates of Hospitalization due to Skin and Soft-Tissue Infections in a Southwest American Indian Population
title_fullStr 451. High Rates of Hospitalization due to Skin and Soft-Tissue Infections in a Southwest American Indian Population
title_full_unstemmed 451. High Rates of Hospitalization due to Skin and Soft-Tissue Infections in a Southwest American Indian Population
title_short 451. High Rates of Hospitalization due to Skin and Soft-Tissue Infections in a Southwest American Indian Population
title_sort 451. high rates of hospitalization due to skin and soft-tissue infections in a southwest american indian population
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808941/
http://dx.doi.org/10.1093/ofid/ofz360.524
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