Delayed initiation of antibiotic therapy is associated with worse outcomes in skin and soft tissue infections
1. Delayed initiation of antibiotic therapy was strongly associated with treatment failure and prolonged hospitalization in hospitalized SSTI patients.
2. Comorbidity burden and socioeconomic disparities significantly influenced SSTI outcomes, highlighting the importance of individualized management and antimicrobial stewardship.
Evidence Rating Level: 3 (Average)
In this prospective observational study, Biyazin et al. evaluated determinants of treatment outcomes among 423 hospitalized patients with skin and soft tissue infections (SSTIs) at a tertiary referral hospital in Ethiopia. SSTIs are associated with substantial morbidity, prolonged hospitalization, and increasing antimicrobial resistance, particularly in settings with inconsistent antimicrobial stewardship and high rates of comorbidity. The investigators assessed early clinical response within 48–72 hours, treatment failure after 72 hours of therapy, hospital length of stay (HLOS), and in-hospital mortality. Multivariable logistic and linear regression analyses were used to identify predictors of treatment failure and prolonged hospitalization. Cellulitis was the most common diagnosis, and diabetes mellitus was the leading comorbidity. Mean HLOS was 13.5 days, 39.3% of patients achieved early clinical response, and 34.4% experienced treatment failure. Delayed antibiotic initiation beyond 12 hours, rural residence, coexisting illness, and higher comorbidity burden were independently associated with worse outcomes and longer hospitalization. Early antibiotic administration, oral step-down therapy, and higher socioeconomic status were associated with shorter HLOS and improved outcomes. The authors conclude that prompt empiric antibiotic therapy, effective source control, and strengthened antimicrobial stewardship are essential to improving SSTI outcomes, particularly in resource-limited settings.
Click here to read the study in BMJ Open
Image: PD
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