Impact and Progression of Organ Dysfunction in Patients with Necrotizing Soft Tissue Infections: A Multicenter Study

Bulger, Eileen M.; May, Addison K.; Bernard, Andrew C.; Cohn, Stephen M.; Evans, David C.; Henry, Sharon M.; Quick, Jacob; Kobayashi, Leslie; Foster, Kevin N; Duane, Therèse M.; Sawyer, Robert G.; Kellum, John A.; Maung, Adrian A.; Maislin, Greg; Smith, David; Segalovich, Irit; Dankner, Wayne M.; Shirvan, Anat

doi:10.1089/sur.2015.098

Cited by 22 publications

(18 citation statements)

References 25 publications

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“…However, because of the severity of illness, underlying co-morbidities and intensity of postoperative wound care, ICU admission is frequently required [22,23,26e31]. Onequarter to one-half of patients with NSTI develop septic shock [23,29,30,32] and/or require mechanical ventilation [26,29,33] and a third exhibit acute kidney injury [30,33,34]. Organ failures tend to worsen in the first 24 hours of admission [34].…”

Section: Epidemiologymentioning

confidence: 99%

“…In one report, only half of them were able to return directly home while the others needed further hospitalization or transfer to an inpatient rehabilitation facility [26]. Importantly, about 10%e 20% of patients with limb NSTI will eventually require amputation [23,27,30,33,34,36,38,42,45].…”

Section: Epidemiologymentioning

confidence: 99%

“…About 20%e30% of patients with NSTI die during their hospital stay [22,24,33,36,39,40], though mortality may be lower depending on case mix [33,34,46,47]. Risk factors for mortality are disease severity, reflected by severity of illness scores such as the APACHE II [33,35,41,45], or hypotension and/or vasopressor need [23,29,36,39].…”

Section: Epidemiologymentioning

confidence: 99%

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Necrotizing skin and soft-tissue infections in the intensive care unit

Peetermans

Prost

Eckmann

et al. 2020

Clinical Microbiology and Infection

100

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Background: Necrotizing skin and soft-tissue infections (NSTI) are rare but potentially life-threatening and disabling infections that often require intensive care unit admission. Objectives: To review all aspects of care for a critically ill individual with NSTI. Sources: Literature search using Medline and Cochrane library, multidisciplinary panel of experts. Content: The initial presentation of a patient with NSTI can be misleading, as features of severe systemic toxicity can obscure sometimes less impressive skin findings. The infection can spread rapidly, and delayed surgery worsens prognosis, hence there is a limited role for additional imaging in the critically ill patient. Also, the utility of clinical scores is contested. Prompt surgery with aggressive debridement of necrotic tissue is required for source control and allows for microbiological sampling. Also, prompt administration of broad-spectrum antimicrobial therapy is warranted, with the addition of clindamycin for its effect on toxin production, both in empirical therapy, and in targeted therapy for monomicrobial group A streptococcal and clostridial NSTI. The role of immunoglobulins and hyperbaric oxygen therapy remains controversial. Implications: Close collaboration between intensive care, surgery, microbiology and infectious diseases, and centralization of care is fundamental in the approach to the severely ill patient with NSTI. As many aspects of management of these rare infections are supported by low-quality data only, multicentre trials are urgently needed.

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Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

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Necrotizing skin and soft-tissue infections in the intensive care unit

Peetermans

Prost

Eckmann

et al. 2020

Clinical Microbiology and Infection

100

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“…134 Necrotizing soft tissue infections involving the fascia and muscle likewise bear high mortality, particularly in those who develop early organ dysfunction. 135 …”

Section: Skin and Soft Tissue Infectionsmentioning

confidence: 99%

Sepsis and Other Infectious Disease Emergencies in the Elderly

Liang

2016

Emergency Medicine Clinics of North America

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“…In an ideal study, measures of cardiovascular and respiratory status, kidney function, and WBC count could be used as additional outcomes. Also, all‐cause inpatient mortality is not the ideal measure of treatment efficacy in sepsis, and novel clinical composite endpoints could be considered in future studies . Finally, our study lacks measurement of biomarkers that may have been removed or replaced by plasma exchange.…”

Section: Discussionmentioning

confidence: 98%