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Prospective study of severity assessment and management of acute medical admissions with skin and soft tissue infection

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Prospective study of severity assessment and management of acute medical admissions with skin and soft tissue infection. / Marwick, Charis; Rae, Nikolas; Irvine, Nicola; Davey, Peter.

In: Journal of Antimicrobial Chemotherapy, Vol. 67, No. 4, 04.2012, p. 1016-1019.

Research output: Contribution to journalArticle

Harvard

Marwick, C, Rae, N, Irvine, N & Davey, P 2012, 'Prospective study of severity assessment and management of acute medical admissions with skin and soft tissue infection' Journal of Antimicrobial Chemotherapy, vol 67, no. 4, pp. 1016-1019., 10.1093/jac/dkr554

APA

Marwick, C., Rae, N., Irvine, N., & Davey, P. (2012). Prospective study of severity assessment and management of acute medical admissions with skin and soft tissue infection. Journal of Antimicrobial Chemotherapy, 67(4), 1016-1019. 10.1093/jac/dkr554

Vancouver

Marwick C, Rae N, Irvine N, Davey P. Prospective study of severity assessment and management of acute medical admissions with skin and soft tissue infection. Journal of Antimicrobial Chemotherapy. 2012 Apr;67(4):1016-1019. Available from: 10.1093/jac/dkr554

Author

Marwick, Charis; Rae, Nikolas; Irvine, Nicola; Davey, Peter / Prospective study of severity assessment and management of acute medical admissions with skin and soft tissue infection.

In: Journal of Antimicrobial Chemotherapy, Vol. 67, No. 4, 04.2012, p. 1016-1019.

Research output: Contribution to journalArticle

Bibtex - Download

@article{ca2c801191b1409b9bba972b51147cc2,
title = "Prospective study of severity assessment and management of acute medical admissions with skin and soft tissue infection",
author = "Charis Marwick and Nikolas Rae and Nicola Irvine and Peter Davey",
year = "2012",
doi = "10.1093/jac/dkr554",
volume = "67",
number = "4",
pages = "1016--1019",
journal = "Journal of Antimicrobial Chemotherapy",
issn = "0305-7453",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - Prospective study of severity assessment and management of acute medical admissions with skin and soft tissue infection

A1 - Marwick,Charis

A1 - Rae,Nikolas

A1 - Irvine,Nicola

A1 - Davey,Peter

AU - Marwick,Charis

AU - Rae,Nikolas

AU - Irvine,Nicola

AU - Davey,Peter

PY - 2012/4

Y1 - 2012/4

N2 - <p>Several severity scoring systems have been proposed for skin and soft tissue infections (SSTIs), but none has been tested prospectively.</p><p>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.</p><p>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).</p><p>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.</p>

AB - <p>Several severity scoring systems have been proposed for skin and soft tissue infections (SSTIs), but none has been tested prospectively.</p><p>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.</p><p>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).</p><p>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.</p>

U2 - 10.1093/jac/dkr554

DO - 10.1093/jac/dkr554

M1 - Article

JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

SN - 0305-7453

IS - 4

VL - 67

SP - 1016

EP - 1019

ER -

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