Necrotizing soft tissue infections – a multicentre, prospective observational study (<scp>INFECT</scp>): protocol and statistical analysis plan

Madsen, Martin Bruun; Skrede, Steinar; Bruun, Trond; Arnell, Per; Rosén, Anders; Nekludov, Michael; Karlsson, Ylva; Bergey, François; Saccenti, Edoardo; Santos, Vítor A. P. Martins dos; Perner, Anders; Norrby‐Teglund, Anna; Hyldegaard, Ole

doi:10.1111/aas.13024

Cited by 31 publications

(51 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Given the incidence of NSTI, international collaborative research is the only way to improve the care of these patients. On this note, a multicentre prospective observational study on NSTI (NCT01790698) [114], including both documentation of clinical and treatment variables as well as biobank collection was recently completed, and results are highly anticipated.…”

Section: Research Perspectivesmentioning

confidence: 99%

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

Peetermans

Prost

Eckmann

et al. 2020

Clinical Microbiology and Infection

Self Cite

100

View full text Add to dashboard Cite

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.

show abstract

Section: Research Perspectivesmentioning

confidence: 99%

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

Peetermans

Prost

Eckmann

et al. 2020

Clinical Microbiology and Infection

Self Cite

100

View full text Add to dashboard Cite

show abstract

“…Description of clinical variables registered in the INFECT project including principles of bacterial categorization are available in a separate publication. 31 Among patients with diagnosed diabetes, available A1C values from up to 6 months before inclusion are retrospectively collected from medical records. Also in retrospect, patients with diabetes will be categorized as type 1, insulin-treated type 2, or non-insulin-treated type 2 based on information from medical records.…”

Section: Registered Variablesmentioning

confidence: 99%

“…The presence of monomicrobial growth of group A streptococci (GAS) in cultures.Tissue and blood samples taken at referring hospital and study hospital are used 31. The presence of monomicrobial growth of group B streptococci in cultures.Tissue and blood samples taken at both referring hospital and study hospital are used 31. The presence of monomicrobial growth of Staphylococcus aureus in cultures.Tissue and blood samples taken at both referring hospital and study hospital are used 31.…”

mentioning

confidence: 99%

“…The presence of monomicrobial growth of Staphylococcus aureus in cultures.Tissue and blood samples taken at both referring hospital and study hospital are used 31. The presence of polymicrobial flora in cultures.Tissue and blood samples taken at both referring hospital and study hospital are used 31. Affected body area at inclusion.Affected body area is defined as either head and neck, upper body (including upper extremities), abdomen and anogenital region, or lower extremities.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Diabetes and necrotizing soft tissue infections—A prospective observational cohort study: Statistical analysis plan

Rosén

Arnell

Madsen

et al. 2018

Acta Anaesthesiol Scand

Self Cite

View full text Add to dashboard Cite

show abstract

“…threating infection of fascia and subcutaneous tissue [1][2][3][4]. The incidence rate based on insurance claims data is 4 per 100,000 person-years [5].…”

mentioning

confidence: 99%

Mortality Risk in Necrotizing Fasciitis: National Prevalence, Trend, and Burden

Al‐Qurayshi

Nichols

Killackey

et al. 2020

Surgical Infections

View full text Add to dashboard Cite

Background: Necrotizing fasciitis (NF) is a fulminant, life-threating infection of fascia and subcutaneous tissue. Because of the low incidence, previous studies were statistically underpowered to assess factors associated with the risk of mortality. The aim of this study is to identify the risk factors associated with mortality in this select group of patients. Methods: A retrospective cross-sectional study was performed utilizing the Nationwide Readmissions Database, 2010-2014. The database captures 56.6% of all U.S. annual hospitalizations. Study population included inpatients admitted emergently with NF. Results: A total of 4,178 cases were included, of which 2,061(48.9%) patients had a history of diabetes mellitus (DM). The most common presentation was septicemia (39.5%) and 9.2% were admitted initially as cellulitis/ abscess. Overall mortality risk was 12.6% with no substantial change in the annual trend. Mortality in patients with diabetes was substantially lower (8.5% vs. 16.5%, odds ratio [OR]: 0.44, 95% confidence interval [CI] = [0.34, 0.56], p < 0.001). Factors associated with a higher mortality risk included: older age, chronic liver diseases, disseminated intravascular coagulopathy, septic shock, pulmonary complications, acute renal failure, and not undergoing surgical intervention (p < 0.05 each). Patients who did not undergo surgical debridement were more likely to be ‡65 years of age and have multiple comorbidities. Hyperbaric oxygen therapy and intravenous immunoglobulin were used in 1.3% and 0.3% of the sample, respectively, with no reported use among patients who died. Conclusions: This study provides a new and updated perspective on the prevalence, trend, and outcomes of NF in the United States. Necrotizing fasciitis is associated with septicemia and lack of surgical intervention is associated with a higher mortality.

show abstract

Necrotizing soft tissue infections – a multicentre, prospective observational study (INFECT): protocol and statistical analysis plan

Cited by 31 publications

References 19 publications

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

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

Diabetes and necrotizing soft tissue infections—A prospective observational cohort study: Statistical analysis plan

Mortality Risk in Necrotizing Fasciitis: National Prevalence, Trend, and Burden

Contact Info

Product

Resources

About