Skin and soft tissue infections in the intensive care unit: a retrospective study in a tertiary care center

Abstract

ObjectiveTo identify factors that may influence outcomes in patients with severe skin and soft tissue infections in the intensive care unit.MethodsA retrospective observational study was conducted in a cohort of 1,123 critically ill patients admitted to an intensive care unit with a primary or secondary diagnosis of severe skin and soft tissues infection between January 2006 and December 2014.ResultsThirty patients were included, 20 (66.7%) of whom were diagnosed with necrotizing fasciitis; in these patients, perineal area involvement was most commonly identified. Abscess was diagnosed in 8 (26.7%) patients, most commonly involving the cervical area. Risk factors such as immunosuppression and previous surgical trauma were commonly observed in this population. The most commonly isolated microorganism was Escherichia coli. Multidrug resistant microorganisms were commonly detected, even in the absence of traditional risk factors; among these patients, previous use of antibiotics was the most common risk factor for drug resistance. The rate of mortality was significantly higher in patients with necrotizing fasciitis (55%, p = 0.035) and associated with disease severity, presence of septic shock, cardiac arrest and leucocytosis.ConclusionDifferent risk factors and etiologies of severe skin and soft tissue infections were identified. Necrotizing fasciitis and drug-resistant bacteria were significant predictors of mortality, even in the absence of traditional risk factors. Obtaining a better understanding of trends in the risk factors and microorganisms associated with severe skin infections may help in the determination of prompt treatment and antibiotic choices.

Baseline Characteristics and Outcomes Among Patients with Complicated Skin and Soft Tissue Infections Admitted to the Intensive Care Unit: Analysis of the Phase 3 COVERS Randomized Trial of Ceftaroline Fosamil Versus Vancomycin Plus Aztreonam

“…However, ICU admission was a risk factor for increased hospital LOS. These findings are consistent with those of a retrospective observational study, in which patients with necrotizing fasciitis, abscess, or cellulitis had median ICU LOS of 8, 14, and 21 days, respectively [ 22 ]. In the REACH study, median hospital LOS for patients admitted to the ICU was 25 days versus 11 days for patients not admitted to the ICU [ 7 ].…”

Necrotizing Skin and Soft Tissue Infections Admitted to Intensive Care Unit in Reunion Island: A Retrospective Cohort Study

“…We observed a mortality of 25.4% in ICU for NSSTI, which is lower than previously reported in ICU: 51% in Korea 7 or 55% in Portugal. 8 Mortality rates reported in other geographic areas were for general hospital mortality: 28% in France, 9 22.4% in Korea, 7 25% in India, 10 or 26% in Qatar. 11 The data for these cases remain difficult to analyze because it is dependent on the admission or nonadmission criteria in ICU for each country.…”

“…We estimate the incidence of severe soft tissue infections requiring ICU at 1.21/ 100,000 person/years on Reunion Island. Severity scores were high with an admission SOFA score of 8 [6][7][8][9][10] and an SAPS II first 24-hour score of 58 . Necrotizing skin and soft tissue infections mainly affected the lower limbs (52 cases, 78%).…”

Streptococcus agalactiae: colonização de gestantes de alto risco em um hospital regional da Amazônia brasileira e perfil de sensibilidade aos antimicrobianos

“…O uso de medicamentos de forma indiscriminada pode promover o surgimento de bactérias multirresistentes, as quais estão associadas a índices elevados de morbimortalidade 40,41 . Com o advento da resistência bacteriana, a identificação do patógeno e o conhecimento sobre o seu perfil de sensibilidade em infecções/colonizações durante a gestação tornaram-se importantes para uma profilaxia intraparto eficiente.…”