Transfer Is Associated with a Higher Mortality Rate in Necrotizing Soft Tissue Infections

Khoury, Mitri K.; Pickett, Maryanne L.; Cripps, Michael W.; Park, So Youn; Nagaraj, Madhuri B.; Hranjec, Tjasa; Hennessy, Sara

doi:10.1089/sur.2019.091

Cited by 11 publications

(4 citation statements)

References 20 publications

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“…11,13 Like most other authors our data also shows a mean of 5 debridements for the survivors thus highlighting the importance of timely repeat serial debridements to arrest the spread of the NSTIs and to ensure improved survival. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Twenty three (32%) patients in our series were received in shock with raised white cell counts and evidence of impaired renal function. The mortality among these patients was 39% (9/23 patients) compared to 16.32% mortality in patients who were not received in shock (8/49 patients).…”

Section: Diabetessupporting

confidence: 77%

“…(Fig- 5A & 5B) either primarily or secondarily led to mortalities even in patients who were not received in shock. These are the findings of most other authors who have written about the subject [1][2][3][4][5][7][8][9]11,13,19 . Delayed or suboptimal primary or subsequent serial debridements 13 and the presence of Clostridial, 20 Acinobacter, 21,22 MRSA or Fungi 15,16,17 as the infecting organisms was related to a higher mortality.…”

Section: Diabetessupporting

confidence: 75%

“…The effect of transfer to such centers and the resulting delay in treatment has been studied by other authors who have found that transfer status is associated with a higher mortality rate in NSTIs. 11,13 We share a similar observation although our data on this aspect is compromised. We feel that a prospective study is warranted to illuminate further what factors contribute to the higher mortality rate in these very ill patients.…”

Section: Diabetessupporting

confidence: 73%

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Predictors of Mortality in Necrotizing Soft Tissue Infections in Adults – Experience at A Tertiary Care Hospital in Pakistan

Majid

Anwar²,

Khalid³

et al. 2021

Proceedings S.Z.M.C

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Introduction: Necrotizing soft tissue infection is a potentially fatal ‘flesh-eating’ disease that requires prompt intervention to save a patient’s life. Identification of parameters that indicate worsening of the disease (predictors of mortality) is an important part in management that guides a surgeon towards rapid surgical treatment. Aims & Objectives: This retrospective study aims to identify factors that are associated with mortality in adults with NSTIs. This study also aims to propose solutions for the better management of these infection to improve surgical outcome and survival. Place and duration of study: OPD & Emergency of Surgical Unit I and II of Shaikh Zayed Hospital, Lahore over a period of 10 years between the years 2010 to 2021. Material & Methods: This is a cross-sectional epidemiological, retrospective study conducted on patients presenting in the Outpatients Department, as well as the Emergency of Surgical Unit I and II. A total of 72 patients meeting the inclusion criteria were enrolled in this study. SPSS version 23 was used for data analysis. Results: Out of 72 patients, 31.94% of patients were receiving some form of immunosuppressive treatment (n=23), out of which 7 patients lost their life (30.43%, p=0.000). There was a preexisting immunosuppressive disease in 48.61% patients (n=35), and in this subset, a total of 10 patients didn’t recover (28.57%, p=0.000). 13 out of 17 patients who died received first debridement after 12 hours from presentation (p=0.021). High mortality was seen in patients who had the presence of shock at hospital admission. Conclusion: Delay in diagnosis and surgical treatment, the presence of shock at admission accompanied by evidence of organ dysfunction, increasing comorbidity index are reasons for the higher mortality seen in these patients of NSTIs. The timing of the first surgery is of the essence thus highlighting the importance of the “Golden Hour” for the Management of NSTIs.

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Section: Diabetessupporting

confidence: 77%

Section: Diabetessupporting

confidence: 75%

Section: Diabetessupporting

confidence: 73%

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Predictors of Mortality in Necrotizing Soft Tissue Infections in Adults – Experience at A Tertiary Care Hospital in Pakistan

Majid

Anwar²,

Khalid³

et al. 2021

Proceedings S.Z.M.C

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“…Another cause of delayed www.co-infectiousdiseases.com management is interhospital transfers to tertiary centres. Several studies addressing this issue led to conflicting results [20], the most recent one suggesting a 5.33 [adjusted odds ratio (aOR); P ¼ 0.04] increased mortality rate of transferred patients [21].…”

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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Necrotising Fasciitis

Schröder

Sochaczewski

2022

Pediatric Musculoskeletal Infections

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Transfer Is Associated with a Higher Mortality Rate in Necrotizing Soft Tissue Infections

Cited by 11 publications

References 20 publications

Predictors of Mortality in Necrotizing Soft Tissue Infections in Adults – Experience at A Tertiary Care Hospital in Pakistan

Predictors of Mortality in Necrotizing Soft Tissue Infections in Adults – Experience at A Tertiary Care Hospital in Pakistan

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

Necrotising Fasciitis

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