Management of skin and soft-tissue infections at a community teaching hospital using a severity-of-illness tool

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Objectives</div>Skin and soft-tissue infections (SSTIs) encompass a diverse range of infections of varying severity. The Clinical Resource Efficiency Support Team (CREST) scoring system stratifies patients into four classes (I = least severe to IV = most severe) based on the Standardized Early Warning Score (SEWS). The objective of this study was to apply CREST to hospitalized patients with SSTIs in order to quantify disease severity and evaluate appropriateness of antibiotic management.<div class="boxTitle">Methods</div>This was a retrospective, hypothesis-generating, single-centre evaluation of hospitalized patients with SSTIs admitted in 2011. Based on CREST classification, the empirical antimicrobial choices were categorized as appropriate, over-treatment or under-treatment.<div class="boxTitle">Results</div>A total of 369 patients were screened and 200 met the inclusion criteria. The majority of patients were classified as either CREST class I (<span style="font-style:italic;">n </span>= 68) or class II (<span style="font-style:italic;">n </span>= 102). Over-treatment was more common in the less severe classes (88% and 32% in class I and class II, respectively; <span style="font-style:italic;">P </span>< 0.05). Sixty-three percent of class I (<span style="font-style:italic;">n </span>= 43) were over-treated due to both the use of intravenous antibiotics when oral therapy was sufficient and use of unnecessarily broad-spectrum antibiotics. In contrast, 25% (<span style="font-style:italic;">n </span>= 26) of class II were over-treated due to use of unnecessarily broad-spectrum antibiotics. Overall clinical failure rates remained low with only 1%, 4% and 17% of patients unable to achieve initial response in class II, class III and class IV.<div class="boxTitle">Conclusions</div>Retrospective application of CREST identified opportunities to improve the management of SSTIs. CREST can be of great value in discriminating less-severe SSTIs, which can be treated on an outpatient basis.</span>

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