Characterization of Necrotizing Soft Tissue Infections in Obese and Non-Obese Patients

Villarreal, Michael; Schubauer, Kathryn; Rosales, Jordan; Gonzales-Gallo, Kathia; Wisler, Jon

doi:10.1089/sur.2022.055

Cited by 5 publications

(6 citation statements)

References 28 publications

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“…34 In another study analyzing the impact of obesity for outcomes following necrotizing soft tissue infections, class II obesity was associated with decreased adjusted in-hospital and 90-day mortality compared with other weight categories. 35 Conversely, Arbabi et al noted that rising BMI was associated with decreased injury severity score in trauma patients but a paradoxical increase in adjusted mortality. 28 Thus, despite a protective "cushion effect" that reduced presenting injury severity, obese patients demonstrated worsened systemic outcomes following traumatic insults.…”

Section: Discussionmentioning

confidence: 99%

Obesity is associated with improved early survival but increased late mortality in surgical patients with Sepsis: A propensity matched analysis

Jalilvand,

Ireland,

Collins

et al. 2024

J Trauma Acute Care Surg

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Introduction While obesity is a risk factor for post-operative complications, its impact following sepsis is unclear. The primary objective of this study was to evaluate the association between obesity and mortality following admission to the surgical ICU (SICU) with sepsis. Methods We conducted a single center retrospective review of SICU patients grouped into obese (n = 766, BMI ≥30 kg/m2) and non-obese (n = 574, BMI 18-29.9 kg/m2) cohorts. Applying 1:1 propensity matching for age, sex, comorbidities, SOFA, and transfer status, demographic data, comorbidities, and sepsis presentation were compared between groups. Primary outcomes included in-hospital and 90-day mortality, ICU length of stay (LOS), need for mechanical ventilation (IMV) and renal replacement therapy (RRT). P < 0.05 was considered significant. Results Obesity associates with higher median ICU LOS (8.2 vs 5.6, p < 0.001), need for IMV (76% vs 67%, p = 0.001), ventilator days (5 vs 4, p < 0.004), and RRT (23% vs 12%, p < 0.001). In-hospital (29% vs 18%, p < 0.0001) and 90-day mortality (34% vs 24%, p = 0.0006) was higher for obese compared to non-obese groups. Obesity independently predicted need for IMV (OR 1.6, 95th CI: 1.2-2.1), RRT (OR 2.2, 95th CI: 1.5-3.1), in-hospital (OR 2.1, 95th CI: 1.5-2.8) and 90-day mortality (HR: 1.4, 95TH CI: 1.1-1.8), after adjusting for SOFA, age, sex, and comorbidities. Comparative survival analyses demonstrate a paradoxical early survival benefit for obese patients followed by a rapid decline after 7 days (logrank p = 0.0009). Conclusions Obesity is an independent risk factor for 90-day mortality for surgical patients with sepsis, but its impact appeared later in hospitalization. Understanding differences in systemic responses between these cohorts may be important for optimizing critical care management. Level of Evidence III

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Section: Discussionmentioning

confidence: 99%

Obesity is associated with improved early survival but increased late mortality in surgical patients with Sepsis: A propensity matched analysis

Jalilvand,

Ireland,

Collins

et al. 2024

J Trauma Acute Care Surg

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“…Overall, obesity leads to immune system dysregulation, a reduced cell-mediated immune response, and modified gut microbiota, representing possible reasons for the increased risk of infection associated with obesity ( 16 , 38 , 71 – 73 ). Similar to the findings reported by Conway et al.…”

Section: Discussionmentioning

confidence: 99%

“…However, recently, it has been found that adipogenesis of the skin is an important source of resistance to infection and antimicrobial peptides ( 13 , 14 ), which contradicts many observations regarding the increased risk of bacterial skin infections in obese individuals ( 15 ). Based on the results of these studies, the causal relationship between obesity and SSTIs is unclear as some confounding factors may have biased the results, such as the strong association between obesity and type 2 diabetes (T2D) and peripheral vascular disease (PVD) ( 5 , 16 ). Therefore, the causal relationship between obesity and SSTIs has not been established.…”

Section: Introductionmentioning

confidence: 99%

The causal relationship between obesity and skin and soft tissue infections: A two-sample Mendelian randomization study

Mei

et al. 2022

Front. Endocrinol.

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ObjectiveMany observational studies have shown that obesity strongly affects skin and soft tissue infections (SSTIs). However, whether a causal genetic relationship exists between obesity and SSTIs is unclear.MethodsA two-sample Mendelian randomization (MR) study was used to explore whether obesity is causally associated with SSTIs using a publicly released genome-wide association study (GWAS). An inverse-variance weighted (IVW) analysis was used as the primary analysis, and the results are reported as the odds ratios (ORs). Heterogeneity was tested using Cochran’s Q test and the I2 statistic, and horizontal pleiotropy was tested using the MR−Egger intercept and MR pleiotropy residual sum and outlier (MR-PRESSO).ResultsThe results of the MR analysis showed a positive effect of BMI on SSTIs (OR 1.544, 95% CI 1.399-1.704, P= 5.86 × 10-18). After adjusting for the effect of type 2 diabetes (T2D) and peripheral vascular disease (PVD), the positive effect still existed. Then, we further assessed the effect of BMI on different types of SSTIs. The results showed that BMI caused an increased risk of impetigo, cutaneous abscess, furuncle and carbuncle, cellulitis, pilonidal cyst, and other local infections of skin and subcutaneous tissues, except for acute lymphadenitis. However, the associations disappeared after adjusting for the effect of T2D and PVD, and the associations between BMI and impetigo or cellulitis disappeared. Finally, we assessed the effects of several obesity-related characteristics on SSTIs. Waist circumference, hip circumference, body fat percentage, and whole-body fat mass, excluding waist-to-hip ratio, had a causal effect on an increased risk of SSTIs. However, the associations disappeared after adjusting for the effect of BMI.ConclusionThis study found that obesity had a positive causal effect on SSTIs. Reasonable weight control is a possible way to reduce the occurrence of SSTIs, especially in patients undergoing surgery.

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“…Diabetes is one of the most common comorbidities, reported in 15–71% of these patients in whom the altered microcirculation could explain the correlation with limb amputation [3,8]. Liver diseases and cirrhosis are observed in 3–53% of patients with NSTIs and are frequently associated with a high mortality rate, while the impact of alcoholism and obesity on prognosis is controversial [3,7,9 ▪ ].…”

Section: Aggravating Effect Of Comorbiditiesmentioning

confidence: 99%

“…In a study addressing NSTIs of the upper extremity, Nawijn et al identified a greater total body surface area affected by SSTIs as a risk factor for mortality (OR 1.05) [24]. In an ICU cohort of NSTI, Tanaka et al confirmed the importance of the skin surface with a twofold increased injured skin surface in deceased patients (9 [7–18] median [interquartile ratio] versus 4.5 [4.5–9] % in survivors, P < 0.001) (OR 1.18) [25 ▪ ]. The absence of intraoperative bleeding during debridement of NSTI cases is also a risk factor for death (OR 8.5), indicating a deep necrotic process [10].…”

Section: Challenges In Source Controlmentioning

confidence: 99%

Identifying patients with difficult-to-treat acute bacterial skin infections

Montravers,

Soussan,

Tanaka

2023

Current Opinion in Infectious Diseases

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Purpose of review The early recognition of acute bacterial skin infections (ABSIs) and their swift and adequate care are the major determinants of success. The features that can hamper or delay surgical and medical management can lead to ‘difficult-to-treat’ ABSIs. Recent findings Delayed diagnosis and belated management are the key obstacles to be overcome. Clinicians should be careful about underestimating the severity of ABSIs and overlooking comorbidities, especially immunosuppression. Many conditions can lead to delayed source control, including a misdiagnosis, interhospital transfers, delayed re-exploration, or extensive injuries. Difficult therapeutic issues can occur, including rapidly destructive infections from highly pathogenic microorganisms (Group-A-streptococci, Vibrio spp., Clostridium spp. and Staphylococcus aureus) or inadequate antibiotic therapy resulting from multidrug-resistant bacteria. Impaired pharmacokinetic capacities of antibiotic agents should also be considered as a source of clinical failure due to insufficient antimicrobial activity at the site of infection. Summary Microbiological samples should be used for guiding antimicrobial therapy. Risk factors for multidrug-resistant bacteria should be considered, including local epidemiology and comorbidities. The optimization of antibiotic therapy should be achieved. Optimized care should be achieved through multidisciplinary management involving professionals with sufficient and appropriate training.

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Characterization of Necrotizing Soft Tissue Infections in Obese and Non-Obese Patients

Cited by 5 publications

References 28 publications

Obesity is associated with improved early survival but increased late mortality in surgical patients with Sepsis: A propensity matched analysis

Obesity is associated with improved early survival but increased late mortality in surgical patients with Sepsis: A propensity matched analysis

The causal relationship between obesity and skin and soft tissue infections: A two-sample Mendelian randomization study

Identifying patients with difficult-to-treat acute bacterial skin infections

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