Management failure in treating skin and soft tissue infections

Risk factors, such as a fever, are associated with failures in the management of skin and soft tissue infections (SSTIs) in emergency department observation units (EDOUs), a review has found.

A management failure in SSTIs is recorded if a patient overstays in the EDOU for more than 28 hours or dies.

Ten studies were included in this review. Of these, six identified risk factors or pre-existing variables present on arrival at the EDOU that were associated with management failure.

The risk factors identified were: high body temperature, an initial high white blood cell count and known exposure to meticillin-resistant Staphylococcus aureus.

Management failure rates ranged from 15%-38% – all as high or higher than the generally accepted EDOU failure rate of 15% – with most being higher than 21.8%. None of the studies reported death.

One of the studies reported anatomical location of the SSTIs. It found that infections of the neck, buttocks, trunk or groin were significantly associated with an increased risk of management failure.

Another study found that SSTIs of the hand, leg and arm were most common, while SSTI of the hand was a significant predictor of management failure and hospital admission.

The authors of the review conclude that recognition of risk factors may help to improve patient outcomes of the management of SSTIs.

However, they recognise that further research needs to be carried out as all the studies were carried out in the US so that generalisation to other countries with differing clinical practices will be limited.

Abetz JW, Adams NG, Mitra B (2018) Skin and soft tissue infection management failure in the emergency department observation unit: a systematic review. Emergency Medicine Journal. 35, 1, 56-61.