Inpatient versus outpatient management of community-acquired acute skin and soft tissue infections. Clinical outcomes and factors associated with eligibility for early discharge

Background Skin and soft tissue infections (SSTIs) cause an increasing demand for inpatient and outpatient medical care. In recent years, health systems have promoted strategies to treat selected patients on an outpatient basis, which may avoid hospital admissions and associated complications. Methods A retrospective, cohort study of adults presenting to the emergency department (ED) with a SSTI between 2018 and 2020. Primary objective: to compare clinical outcomes in patients with SSTI treated as outpatients or inpatients. Primary outcome: Early clinical failure. Secondary outcomes: Recurrences, unplanned readmissions and ED visits related to the SSTI. Secondary objective: to investigate factors associated with eligibility for early discharge of inpatients. Logistic regression analysis was used to control for confounding factors. Results Three hundred twenty patients were included, 160 hospitalized. The median hospital stay was 9 days (IQR 5–15), and 20 patients (12.5%) were discharged within 72 h after admission. In multivariate analysis, no differences were observed between groups in rates of early clinical failure, recurrences and unplanned readmissions. Hospitalized patients were significantly less likely to revisit the emergency department for SSTI-related issues (OR 0.32, 95% CI 0.16–0.62; p = 0.001). Social and economic barriers to medical care were associated with lower probability of being eligible for early discharge (OR 0.19 95% CI 0.07–0.54; p = 0.002). The severity of the infection was associated with failure to meet the eligibility criteria for early discharge (OR 0.92 95% CI 0.88–0.96; p < 0.001). Conclusions There were no differences in early clinical failure between admitted and non-admitted patients. Social and economic barriers to medical care and severity of infection were associated with not fulfilling the criteria for eligibility for early discharge.