Patient’s characteristics and outcomes in necrotising soft-tissue infections: results from a Scandinavian, multicentre, prospective cohort study

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

doi:10.1007/s00134-019-05730-x

Cited by 95 publications

(182 citation statements)

References 38 publications

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“…Increasing age has been reported as a risk factor of death in numerous of studies, but conflicting evidence exists as to whether female sex is an independent risk factor or not. 2 18 …”

Section: Discussionmentioning

confidence: 99%

“… 1 The infection can be either monomicrobial or polymicrobial, caused by numerous organisms but most commonly by group A streptococcus. 2 Immediate, aggressive and radical surgical debridement is key in the management of NSTI. Despite rigorous treatment, patients with NSTI have high mortality rates, risk of amputation and often have prolonged hospital and rehabilitation stays.…”

Section: Introductionmentioning

confidence: 99%

“…Of these, one receives patients from all parts of the country for centralised treatment using a multidisciplinary protocol, including HBOT. 2 This should be of benefit, as an increased rate of survival has been shown in patients with NSTI who are treated in high-volume NSTI centres where expertise can be developed. 18 However, as many patients with NSTI have septic shock and multiple organ failure, the delayed time taken for transportation to a centralised treatment hospital by air or road ambulance can pose a risk to life, and therefore, is not always feasible.…”

Section: Introductionmentioning

confidence: 99%

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Incidence, comorbidity and mortality in patients with necrotising soft-tissue infections, 2005–2018: a Danish nationwide register-based cohort study

Hedetoft

Madsen

et al. 2020

BMJ Open

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ObjectiveTo assess the incidence, comorbidities, treatment modalities and mortality in patients with necrotising soft-tissue infections (NSTIs) in Denmark.DesignNationwide population-based registry study.SettingDenmark.ParticipantsDanish residents with NSTI between 1 January 2005 and 31 August 2018.Main outcome measureIncidence of disease per 100 000 person/year and all-cause mortality at day 90 obtained from Danish National Patient Registry and the Danish Civil Registration System.Results1527 patients with NSTI were identified, yielding an incidence of 1.99 per 100 000 person/year. All-cause 30-day, 90-day and 1-year mortality were 19.4% (95% CI 17.4% to 21.5%), 25.2% (95% CI 23.1% to 27.5%) and 30.4% (95% CI 28.0% to 32.8%), respectively. Amputation occurred in 7% of the individuals. Diabetes was the most predominant comorbidity affecting 43% of the cohort, while 26% had no comorbidities. Higher age, female sex and increasing comorbidity index were found to be independent risk factors of mortality. Admission to high-volume hospitals was associated with improved survival (OR 0.59, 95% CI 0.45 to 0.77). Thirty-six per cent received hyperbaric oxygen therapy (HBOT) as an adjunctive therapy. No change in overall mortality was found over the studied time period.ConclusionThe present study found that in Denmark, the incidence of NSTI increased; mortality rates remained high and largely unaltered. Diabetes was the most common comorbidity, while higher age, female sex and increasing comorbidity index were associated to increased mortality. Survival was improved in those admitted to hospitals with more expertise in treating NSTI. In high-volume hospital, HBOT was associated with decreased odds for mortality.

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“…Increasing age has been reported as a risk factor of death in numerous of studies, but conflicting evidence exists as to whether female sex is an independent risk factor or not. 2 18 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence, comorbidity and mortality in patients with necrotising soft-tissue infections, 2005–2018: a Danish nationwide register-based cohort study

Hedetoft

Madsen

et al. 2020

BMJ Open

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“…Patient inclusion is outlined in Supplementary figure 1. All patients were enrolled in the INFECTproject [11](ClinicalTrials.gov, NCT01790698); a multicenter, prospective observational cohort study on NSTI. Some patients were co-enrolled in the INSTINCT trial [1] (ClinicalTrials.gov, NCT02111161).…”

Section: Patient Samplesmentioning

confidence: 99%

Correlation Between Immunoglobulin Dose Administered and Plasma Neutralization of Streptococcal Superantigens in Patients With Necrotizing Soft Tissue Infections

Bergsten

Madsen

Bergey

et al. 2020

Clinical Infectious Diseases

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Analyses of plasma collected pre- and postadministration of intravenous immunoglobulin (IVIG) from patients with group A Streptococcus necrotizing soft tissue infections demonstrated a negative correlation between IVIG dose and toxin-triggered T-cell proliferation (r = −.67, P < .0001). One 25-g IVIG dose was sufficient to yield plasma-neutralizing activity against streptococcal superantigens.

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“…IAI was community-acquired in 31%, mortality was almost 30% and prevalence of multidrug-resistance 26.3% (with great variation according to geographic region but without difference between community-acquired and hospital-acquired IAI). Madsen et al conducted a Scandinavian, multicentre, prospective cohort study in 409 adults with necrotising soft-tissue infections NSTI [2]. The main finding was the surprisingly low (18%) 90-day mortality despite the presence of septic shock in half of the population, acute kidney injury in 20% and comorbidity in 70%.…”

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confidence: 99%

Focus on infection

2020

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Patient’s characteristics and outcomes in necrotising soft-tissue infections: results from a Scandinavian, multicentre, prospective cohort study

Cited by 95 publications

References 38 publications

Incidence, comorbidity and mortality in patients with necrotising soft-tissue infections, 2005–2018: a Danish nationwide register-based cohort study

Incidence, comorbidity and mortality in patients with necrotising soft-tissue infections, 2005–2018: a Danish nationwide register-based cohort study

Correlation Between Immunoglobulin Dose Administered and Plasma Neutralization of Streptococcal Superantigens in Patients With Necrotizing Soft Tissue Infections

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