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

Authors
Cho, Yong KyunWoo, Heung JeongKim, Shin WooBae, In-GyuSong, Young GooCheong, Hee JinLee, HyuckHan, Sang HoonChoi, Hee JungMoon, ChisookRyu, Seong YeolHur, JianLee, Ja CobJo, Yu MiKim, Young Joo
Issue Date
Nov-2020
Publisher
KOREAN ASSOC INTERNAL MEDICINE
Keywords
Complicated skin and skin structure infection; Economic; Clinical burden; Initial antibiotics
Citation
KOREAN JOURNAL OF INTERNAL MEDICINE, v.35, no.6, pp.1497 - 1506
Indexed
SCIE
SCOPUS
KCI
Journal Title
KOREAN JOURNAL OF INTERNAL MEDICINE
Volume
35
Number
6
Start Page
1497
End Page
1506
URI
https://scholarworks.bwise.kr/gnu/handle/sw.gnu/6034
DOI
10.3904/kjim.2018.374
ISSN
1226-3303
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, 34o 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.
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