Local variations in the epidemiology, microbiology, and outcome of necrotizing soft-tissue infections: a multicenter study

Kao, Lillian S.; Lew, Debbie F.; Arab, Samer N.; Todd, S. Rob; Awad, Samir S.; Carrick, Matthew M.; Corneille, Michael G.; Lally, Kevin P.

doi:10.1016/j.amjsurg.2010.07.041

Cited by 110 publications

(118 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Delays in instigation of appropriate treatment are associated with significant long-term morbidity with mortality ranging from 9% to more than 25% [3,4]. Early and repeated debridement of affected planes in combination with use of broad-spectrum antibiotics improves overall outcome [5].…”

Section: Introductionmentioning

confidence: 99%

Outcomes following necrotising fasciitis: an 8-year review

Watson¹,

Hassan²,

Davies³

2014

Res J Infect Dis

View full text Add to dashboard Cite

Background: Necrotising soft tissue infections (NSTI) are uncommon and remain a devastating disease. This study aims to document mortality rates, assess the value of the laboratory risk indicator for necrotising fasciitis (LRINEC) score as a diagnostic tool and examine outcomes following reconstructive surgery for wound closure. Methods: A retrospective case note review of patients presenting to our institute between 2004 and 2012 with a histological or clinical diagnosis of necrotising fasciitis were identified. Results: Thirty-three patients with primary NSTI were identified with a male to female ratio of 1.6:1 and an average age of 50 years. Two patients with secondary reconstruction were identified with a male to female ratio of 1:1 and an average age of 63 years. Twenty patients required admission to the intensive care unit. On average each patient required two tissue debridements under anaesthesia to achieve a healthy wound base suitable for reconstruction. Reconstruction with an anterolateral fasciocutaneous thigh flap (ALT) was carried out in two patients (6%), delayed split skin grafting in thirteen patients (39%) and limb amputation in three patients (9%). Partial flap loss with skin necrosis requiring debridement and advancement occurred in both patients who underwent ALT, whilst complete loss of skin graft occurred in one patient. Thirty-day mortality was 27% with an average time from presentation to death approximately 5 days. Conclusion: Our experience of managing necrotising soft tissue infections has been mixed. Early diagnosis and aggressive debridement with frequent monitoring and return to theatre are essential. These interventions must be coupled with early administration of antimicrobials and supportive fluid resuscitation to provide optimal treatment in the care of NSTI patients.

show abstract

Section: Introductionmentioning

confidence: 99%

Outcomes following necrotising fasciitis: an 8-year review

Watson¹,

Hassan²,

Davies³

2014

Res J Infect Dis

View full text Add to dashboard Cite

show abstract

“…Most NSTI studies have focused instead on identification of this relatively rare disease [3,6,7] or prediction of death [8,9]. Because of the relative paucity of NSTI cases, larger series involve multiple centers experienced in the treatment of critically ill patients with complex surgical infection.…”

mentioning

confidence: 99%

“…Kao et al [6] broadly described presentation, treatment, and outcome from NSTI at six academic hospitals in Texas. They found that patient characteristics, particularly age and severity of disease, were independent predictors of death and postulated that practice variations may affect outcome.…”

mentioning

confidence: 99%

A Multi-Center Review of Care Patterns and Outcomes in Necrotizing Soft Tissue Infections

Faraklas

Yang

Eggerstedt

et al. 2016

Surgical Infections

View full text Add to dashboard Cite

Background: Surgical debridement and broad-spectrum empiric antibiotics are first-line therapy for necrotizing soft tissue infections (NSTI). The objective of this multi-center retrospective review was to evaluate antimicrobial agent initiation and duration and compare outcomes in the treatment of patients with NSTI. Patients and Methods: This review included adults with NSTI, as indicated by International Classification of Diseases, 9th Edition, Clinical Modification codes 728.86, 608.33, or 040.0, who were admitted to three academic institutions between 1/1/09 and 5/15/14. Demographics, antibiotic practices, operative management, and clinical outcomes were compared. Results: A total of 341 patients were identified at the three centers. Subjects were comparable in age (median 53 years, p = 0.14), gender (67% male, p = 0.57) and body mass index (median 31.9 (p = 0.31) between sites. No significant difference was found in time from admission to start of empiric antibiotic therapy between the three centers (median 1 d for each, p = 0.70), but duration of antibiotic therapy was significantly different (Site A = 16 d, Site B = 12 d, Site C = 9 d, medians, p < 0.001). Although total number of operations differed between sites (median of two at Sites A and B, three at Site C, p = 0.001), sites consistently operated on the day of patient arrival to their facility, and the number of debridements did not differ (median of two for all sites, p = 0.10). Mortality rate (Site A = 22%, Site B = 18%, and Site C = 9%, p = 0.02) and length of stay for survivors (Site A = 29 d, Site B = 16 d, Site C = 19 d, medians, p = 0.001) was significantly different among centers. Conclusions: Variation in antibiotic duration between centers with expertise in the care of NSTI illustrates how little is known about best care practices for patients with NSTI. Future studies should emphasize development of evidence-based practices for NSTI management to further improve the outcomes of this complex group of patients.

show abstract

“…Die Gesamtletalität wird in der Literatur mit etwa 20 % angegeben. Während sie im Zeitraum von 1980 bis 2000 noch durchgehend bei 20-32 % lag, konnte durch eine Verbesserung der Therapie eine signifikante Reduktion der Letalität auf unter 20 % erreicht werden [6,9,10,20]. Neben der antibiotischen Therapie ist die verbesserte chirurgische Therapie ein Hauptgrund für diesen Fortschritt.…”

Section: Epidemiologieunclassified