Prospective study of severity assessment and management of acute medical admissions with skin and soft tissue infection
Prospective study of severity assessment and management of acute medical admissions with skin and soft tissue infection
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DOI：
10.1093/jac/dkr554
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发表时间：
2012-04-01
影响因子：
5.2
通讯作者：
Davey, Peter
中科院分区：
文献类型：
--
作者：
Marwick, Charis;Rae, Nikolas;Davey, Peter
已经提出了几种皮肤和软组织感染（SSTIs）的严重程度评分系统，但都没有进行前瞻性测试。我们前瞻性地纳入了2009年4月至2010年6月期间因急性SSTI入院的成人患者。使用两种建议的SSTI评分系统评估严重程度，其中一种基于通用败血症定义。将抗菌药物处方与指南建议进行比较。我们招募了79名患者。其中一个评分系统将47例患者分为I类（无脓毒症或合并症），5例患者分为II类（无脓毒症，但合并症），34例患者分为III类[脓毒症，但标准化预警系统（SEWS） 4]， 14例患者分为IV类（脓毒症伴SEWS epsilon 4）。另一个系统将39个列为轻度，61个列为中度/重度。两种评分系统之间存在显著差异。在最初24小时的最差临床观察中，19例患者的病情比入院时明显更严重。根据入院观察，13例脓毒症患者治疗不足，根据最坏的观察，增加到22例。79%的败血症患者在入院后4小时内接受了抗生素治疗。这与较少的不良后果相关（P0.05）。急诊医疗单位对性侵犯受害者的管理还有很大的改进空间。特定SSTI严重程度评分比一般脓毒症评估的附加价值需要在更大的前瞻性研究中验证。我们已经改变了SSTI的抗生素政策，使用通用脓毒症评分，并强调在入院当天对患者进行重新评估的必要性。
Several severity scoring systems have been proposed for skin and soft tissue infections (SSTIs), but none has been tested prospectively.We prospectively enrolled adult, acute medical admissions with SSTI between April 2009 and June 2010. Severity was assessed using two proposed SSTI scoring systems, one based on a generic sepsis definition. Antimicrobial prescribing was compared with guideline recommendations.We enrolled 79 patients. One of the scoring systems classified 47 into class I (no sepsis or comorbidity), 5 into class II (no sepsis, but comorbidity), 34 into class III [sepsis, but standardized early warning system (SEWS) 4], and 14 into class IV (sepsis with SEWS epsilon 4). The other system classified 39 as mild and 61 as moderate/severe. There were significant discrepancies between the two scoring systems. Using the worst clinical observations in the first 24 h, 19 of patients had more severe disease than was apparent on admission. Under-treatment of patients with sepsis occurred in 13 of patients according to admission observations, increasing to 22 according to the worst observations. Seventy-nine percent of patients with sepsis received antibiotics within 4 h of admission. This was associated with fewer adverse outcomes (P0.05).There is significant room for improvement in the management of SSTIs presenting to acute medical units. The added value of specific SSTI severity scores over generic sepsis assessment requires validation in a larger prospective study. We have changed our antibiotics policy for SSTI to use generic sepsis scores, and we emphasize the need to reassess patients on the day of admission.