Critical care burden of skin and soft tissue infection in Central Australia: More than skin deep

© 2019 National Rural Health Alliance Ltd. Objective: To describe the epidemiology, critical care resource use of and outcomes from an intensive care admission for a skin or soft tissue infection in Central Australia. Design: Retrospective database review of prospectively collected data identifying all patients requiring admission for a life-threatening illness related to a skin or soft tissue infection. Setting: Intensive care unit Alice Springs Hospital. Participants: All patients admitted with a primary diagnosis of skin or soft tissue infection between 2010 and 2016. Main outcome measure: Annualised incidence of skin or soft tissue infection requiring intensive care. Secondary outcomes examined resource use (length of stay, mechanical ventilation) and a description of the microbiology of skin or soft tissue infection in Central Australia. Results: There were 80 admissions to the intensive care unit over the sampling period, yielding an annualised incidence of 24.2 intensive care unit admissions per 100 000 population. Eighty-five per cent were Indigenous with high rates of co-morbid disease including poorly controlled type 2 diabetes, haemodialysis-dependent chronic kidney disease and co-infection with human T-cell lymphocytic virus. The predominant type of skin or soft tissue infection was abscess, predominantly below the waist. Gram-positive cocci comprised 50% of the organisms cultured, and 20% of organisms were multi-resistant. Mortality was 0% and 1.3% at 28 and 90 days respectively. Conclusion: The annualised incidence of skin or soft tissue infection requiring intensive care support in Central Australia is higher than expected. This probably reflects the high burden of chronic disease and poor living conditions. While there is no mortality burden associated with skin or soft tissue infection in Central Australia, there is substantial morbidity. The data from this study adds weight to the call for improved primary health resources for this group.