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Skin and Soft Tissue Infections: What factors are associated with recurrent infections?

Skin and Soft Tissue Infections: What factors are associated with recurrent infections?

If you’ve never had or seen a serious skin or soft tissue infection (SSTI), it’s probably best not to search Google images unless you’ve finished your lunch. SSTIs can be unsightly and cause immense pain and anguish. They manifest on skin and muscle and can occur on any part of the body. Fortunately, most mild cases of SSTIs are easy to treat, but more serious SSTIs can lead to life-threatening general infections. They also have a tendency to recur.

So, in addition to being painful and hard to look at, recurrences increase treatment costs both for the individual and for the healthcare system. These factors led CDDEP researchers and collaborators to try to find out just how often patients show up for treatment of recurrences and what factors are most commonly associated with recurrence, which could ultimately help reduce repeat visits. They studied data from emergency department (ED) visits in California for the years 2005 to 2011 to find out how often people return to the ED with a recurrent infection and the factors that could predict these recurrent infections.

They found that approximately 16 percent of SSTIs had at least one return trip to the ED with a recurrent SSTI and that this rate was affected by both medical and socio-demographic factors. Patients who were alcohol or drug abusers, had liver disease, or were obese all had an increased risk of recurrence – not surprising, given their association with other medical problems. Interestingly, patients with AIDS, cancer, or diabetes were less likely to return with a recurrent infection, which may be explained by more aggressive medical/drug treatment of the initial infection, or different health care seeking behaviors. From a socio-demographic standpoint, patients living in rural areas and patients on private insurance were less likely to return with an SSTI, compared to those living in urban areas and those on Medicare or self-pay.

SSTI recurrence is not only a problem in the ED and not everyone with a recurrence returns to the ED. Some patients likely sought recurrence care in outpatient clinics or doctors’ offices, so these results are undoubtedly an underestimate of the actual rate of recurrence.

To determine how to prevent SSTI recurrences, future studies should include a range of patient care settings and consider looking at specific types of SSTIs individually, such as cellulitis, impetigo, and folliculitis.  

With this study, we’re one step closer to bringing into focus the factors that lead to an increased risk of SSTI recurrence. The findings are important for targeting populations at greater risk of infection and for improving access to care for those in greater need. So next time a patient walks in with an SSTI, hopefully it will be their last.

The study is published in Epidemiology & Infection, available here.

Nestor Mojica is a Reseach Analyst at CDDEP.

Image via Rosser 321 (CC BY-SA 2.0)