Clinical pathways of hospitalized extremity soft-tissue infections: a retrospective study.

Abstract

Background: Bacterial infections of the skin and soft tissues (SSTIs) are common and should be considered a key differential diagnosis in patients presenting with redness and swelling in these areas. They range from mild superficial cases to severe, complicated forms requiring prompt antimicrobial therapy and, often, surgical intervention. We aimed to describe clinical pathways, diagnostic evolution, treatment strategies, and outcomes in a hospitalized orthopedic/trauma surgery cohort.

Methods: We performed a retrospective single-center analysis of all inpatients treated for extremity SSTIs between January 2020 and December 2023. Extracted variables included demographics, admission and discharge diagnoses, inflammatory markers, imaging, microbiology, surgical procedures, antibiotic regimens and duration, intensive care unit (ICU) utilization, and in-hospital outcomes.

Results: A total of 242 patients were included (mean age 55.7 ± 20.3 years; 40.1% female), with a median length of stay of 7.5 days. ICU care was required in 25/242 10.3%; in-hospital mortality was 7/242 2.9%. Surgical management was required in 134/242 patients (55.4%). Comorbidity burden was substantial (ASA III-IV: 41.3%), and sepsis was documented in 32/242 (13.2%). Diagnostic classification changed between admission and discharge in 80/242 cases (33.1%) of cases. Inflammatory markers declined markedly from admission to discharge (CRP 43.0 [Range: 0.6-640.2, IQR: 13.2-107.5] to CRP: 13.1 [Range: 0.4-541.0, IQR: 4.6-35.2]; leukocytes 11.9 ± 6.09 10/L to 7.68 ± 4.25 10⁹/L). The hand, lower leg and foot were the most frequent sites. CT was performed in 111/242 (45.9%) and ultrasound in 65/242 (26.9%), with heterogeneous imaging strategies (CT only 87/242 (36.0%), US only 41/242 (16.9%), both 24/242 (9.9%), none 90/242 (37.2%)). CT use clustered with higher admission CRP and higher operative burden, including more re-interventions among operated patients. Cultures were frequently negative; when positive, staphylococci and streptococci predominated. Ampicillin/sulbactam and amoxicillin/clavulanate were the most common antibiotics, with frequent IV combination therapy.

Conclusions: Hospitalized extremity SSTIs were characterized by frequent diagnostic reclassification, heterogeneous documentation and imaging pathways, and a high rate of operative management despite overall favorable outcomes. CT was more frequently used in patients with higher inflammatory activity and greater procedural burden. This descriptive association may, at least in part, reflect differences in clinical severity and selection for imaging. The findings support structured reassessment and targeted imaging when anatomical clarification is likely to alter management.