Epidemiology, clinical patterns, and treatment outcomes of patients with acute skin and soft tissue infections at the regional hospital Bamenda

Abstract

Skin and soft tissue infections (SSTIs) present a substantial clinical and economic burden globally, particularly in resource-limited settings. They range from superficial cellulitis to life-threatening conditions like necrotizing fasciitis. Localized clinical tracking establishing regional epidemiological trends and short-term prospective outcomes is vital to guide empiric management protocols in low-income settings where routine diagnostic microbiological support is limited. To evaluate the epidemiology, clinical presentations, and 3-week treatment outcomes of patients presenting with acute soft tissue infections at the Bamenda Regional Hospital (BRH), Cameroon. This hospital-based prospective observational study enrolled eligible adult patients over a four-month period (April to July 2024) at the emergency and surgical units of BRH. Patients were tracked using standardized data collection forms and followed up for 3 weeks’ post-treatment initiation. Functional physical status was monitored using the non-parametric Eastern Cooperative Oncology Group (ECOG) performance scale. Data were analyzed using SPSS version 26. Categorical associations were evaluated using the Chi-squared test and Fisher’s exact test, while longitudinal changes in the ordinal functional scores were assessed via the Wilcoxon signed-rank test. Statistical significance was set at ( p  < 0.05). Out of 6,823 total aggregate emergency and surgical department consultations during the study period, 81 participants met the inclusion criteria, revealing an institutional SSTI prevalence of 1.2%. The cohort comprised 54 males (66.7%) and 27 females (33.3%) with a mean age of 45.9 ± 16.4 years; the highest prevalence occurred in adults aged 31 to 40 years (28.4%). Localized swelling (98.8%) and acute pain (97.5%) were the most frequent complaints at presentation. Categorization by tissue destruction revealed that non-necrotizing infections predominated (\( n  = 61\), 75.3%), driven by cellulitis (37.0%) and cutaneous abscesses (32.1%), localized primarily to the lower limbs (65.9%). Combined medical and surgical interventions were administered to 70.4% of the cohort. At the 3-week evaluation, 20 patients (24.7%) developed severe complications most frequently systemic sepsis, acute kidney injury (AKI), and secondary lower-limb amputations. The crude mortality rate was 2.5% ( n  = 2), occurring during active inpatient care. Non-parametric analysis demonstrated that the median ECOG score improved significantly from 3 (IQR: 2–3) at admission to 1 (IQR: 0–1) at 3 weeks ( p  < 0.001). However, the development of an acute complication was strongly associated with a failure of functional recovery ( p  = 0.017). The institutional prevalence of acute SSTIs was 1.2%, presenting predominantly as lower-limb cellulitis and abscesses among working-age adults aged 31 to 40 years. While overall functional recovery was high, the onset of severe complications significantly delays recovery. These findings underscore the critical need for early clinical risk stratification, implementation of objective triage tracks, and proactive prevention of systemic complications in regional African settings.