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

 Yong Kyun Cho  ;  Heung Jeong Woo  ;  Shin Woo Kim  ;  In-Gyu Bae  ;  Young Goo Song  ;  Hee Jin Cheong  ;  Hyuck Lee  ;  Sang Hoon Han  ;  Hee Jung Choi  ;  Chisook Moon  ;  Seong Yeol Ryu  ;  Jian Hur  ;  Ja Cob Lee  ;  Yu Mi Jo  ;  Young Joo Kim 
 KOREAN JOURNAL OF INTERNAL MEDICINE, Vol.35(6) : 1497-1506, 2020-11 
Journal Title
Issue Date
Clinical burden ; Complicated skin and skin structure infection ; Economic ; Initial antibiotics
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.

Conclusion: 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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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Song, Young Goo(송영구) ORCID logo https://orcid.org/0000-0002-0733-4156
Han, Sang Hoon(한상훈) ORCID logo https://orcid.org/0000-0002-4278-5198
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