Early discharge criteria in patients with acute bacterial skin and skin structure infections in a large tertiary-care teaching hospital in Florence, Italy.

The study is aimed at retrospectively estimating the percentage of inpatients with severe acute bacterial skin and skin structure infections (ABSSSI) who met the early discharged (ED) criteria adapted from Nathwani et al. (Int J Antimicrob Agents. 2016 Aug;48(2):127-36) and to calculate the number of hospitalization days that could be potentially saved. A retrospective study was conducted in a tertiary care hospital in Florence, Italy. We included all patients admitted for cellulitis and post-surgical infections from 2014 to 2017. Demographic and clinical data were obtained from electronic medical records. We a priori defined the following as a risk factor for non-adherence (RFNA): active or on methadone intravenous drug users, homeless, migrants without health care assistance, and patients who need a caregiver to take prescribed medications. One hundred sixty-two subjects were enrolled. Of them, 94 (58.0%) were male, and 113 (69.7%) had cellulitis/erysipelas. A microbiological isolate was obtained in 51 patients (31.4%); Staphylococcus aureus was the most frequent (47%). Eighty-four (51.8%) were ED suitable, with 258 (49.0%) patient days potentially saved. Among the 78 not ED suitable patients, the most common reason for prolonged length of stay (LOS) was having at least one RFNA (34.6%). Fourteen (18.0%) had one RFNA. Half of the patients admitted in our hospital met the ED criteria with a sparing close to 50% in terms of hospitalization days. Unstable social and personal factors were the most frequent causes for prolonged LOS. In this selected subset of patients, more recent and easier to administer treatments, including long-acting agents, could be proposed.

Intravenous immune globulin usage for neurological and neuromuscular disorders: an academic centre, 4 years experience.

Intravenous immune globulin (IVIg) use for labeled and unlabeled indications has grown in the last years. Aim of this study was to evaluate the IVIg usage profile for neurological inpatients in a single academic medical centre, over a long period of time. We retrospectively reviewed all approved IVIg transfusions for neurological disorders at Careggi Hospital from 2003 to 2006. The pharmacy records were then cross-referenced with patient medical records to determine the indication for IVIg administration. From 2003 to 2006 we observed a tremendous increase in IVIg administration, in the annual number of treated patients and in the mean annual courses. Fifty-seven patients (24%) received a long-term IVIg treatment, which accounted for 61% of the total IVIg consumption. The use of IVIg continues to expand despite concerns on future availability and long-term safety; alternative treatment strategies in chronic neurological disorders which require long-term, potentially indefinite therapy are warranted.