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The clinical and economic burden of community-onset complicated skin and skin structure infections in Korea

Korean Journal of Internal Medicine 2020년 35권 6호 p.1497 ~ 1506
조용균, 우흥정, 김신우, 배인규, 송영구, 정희진, 이혁, 한상훈, 최희정, 문치숙, 류성렬, 허지안, Lee Ja-Cob, 조유미, 김영주,
소속 상세정보
조용균 ( Cho Yong-Kyun ) - Gachon University College of Medicine Department of Internal Medicine
우흥정 ( Woo Heung-Jeong ) - Hallym University College of Medicine Department of Internal Medicine
김신우 ( Kim Shin-Woo ) - Kyungpook National University School of Medicine Department of Internal Medicine
배인규 ( Bae In-Gyu ) - Gyeongsang National University School of Medicine Department of Internal Medicine
송영구 ( Song Young-Goo ) - Yonsei University College of Medicine Department of Internal Medicine
정희진 ( Cheong Hee-Jin ) - Korea University College of Medicine Department of Internal Medicine
이혁 ( Lee Hyuck ) - Dong-A University College of Medicine Department of Internal Medicine
한상훈 ( Han Sang-Hoon ) - Yonsei University College of Medicine Department of Internal Medicine
최희정 ( Choi Hee-Jung ) - Ewha Womans University School of Medicine Department of Internal Medicine
문치숙 ( Moon Chi-Sook ) - Inje University College of Medicine Department of Internal Medicine
류성렬 ( Ryu Seong-Yeol ) - Keimyung University School of Medicine Department of Internal Medicine
허지안 ( Hur Ji-An ) - Yeungnam University College of Medicine Department of Internal Medicine
 ( Lee Ja-Cob ) - Hallym University College of Medicine Department of Internal Medicine
조유미 ( Jo Yu-Mi ) - Gachon University College of Medicine Department of Internal Medicine
김영주 ( Kim Young-Joo ) - Pfizer Pharmaceuticals Korea Ltd.

Abstract


Background/Aims: To investigate epidemiologic characteristics, clinical and economic burdens, and factors associated with mortality in complicated skin and skin structure infection (cSSSI) patients in Korea.

Methods: A retrospective, observational, nationwide study was conducted between April to July 2012 at 14 tertiary-hospitals in Korea. Eligible patients were hospitalized adults with community acquired cSSSI, who underwent surgical intervention and completed treatment between November 2009 and October 2011. Data on demography, clinical characteristics, outcomes and medical resource utilization were collected through medical record review. Direct medical costs were calculated by multiplying quantities of resources utilized by each unit price in Korea.

Results: Of 473 patients enrolled, 449 patients (except 24 patients with no record on surgical intervention) were eligible for analysis. Microbiological testing was performed on 66.1% of patients and 8.2% had multiple pathogens. Among culture confirmed pathogens (n = 297 patients, 340 episodes), 76.2% were gram-positive (Staphylococcus aureus; 41.2%) and 23.8% were gram-negative. The median duration of hospital stay was 16 days. Among treated patients, 3.3% experienced recurrence and 4.2% died in-hospital. The mean direct medical costs amounted to $4,195/ person, with the greatest expenses for hospitalization and antibiotics. The in-hospital mortality and total medical costs were higher in combined antibiotics therapy than monotherapy (p < 0.05). Charlson’s comorbidity index ≥ 3, standardized early warning scoring ≥ 4, sub-fascia infections and combined initial therapy, were all found to be associated with higher mortality.

Conclusions: Korean patients with community-onset cSSSI suffer from considerable clinical and economic burden. Efforts should be made to reduce this burden through appropriate initial treatment.

키워드

Complicated skin and skin structure infection; Economic; Clinical burden; Initial antibiotics

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