scholarly journals Risk Factors and Predictors of Mortality in Streptococcal Necrotizing Soft-tissue Infections: A Multicenter Prospective Study

2020 ◽  
Author(s):  
Trond Bruun ◽  
Eivind Rath ◽  
Martin Bruun Madsen ◽  
Oddvar Oppegaard ◽  
Michael Nekludov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Soft Tissue ◽  
Blunt Trauma ◽  
Gene Profiling ◽  
Soft Tissue Infections ◽  
Lasso Regression ◽  
Factors Associated ◽  
Necrotizing Soft Tissue Infections ◽  
The Impact

Abstract Background Necrotizing soft-tissue infections (NSTI) are life-threatening conditions often caused by β-hemolytic streptococci, group A Streptococcus (GAS) in particular. Optimal treatment is contentious. The INFECT cohort includes the largest set of prospectively enrolled streptococcal NSTI cases to date. Methods From the INFECT cohort of 409 adults admitted with NSTI to 5 clinical centers in Scandinavia, patients culture-positive for GAS or Streptococcus dysgalactiae (SD) were selected. Risk factors were identified by comparison with a cohort of nonnecrotizing streptococcal cellulitis. The impact of baseline factors and treatment on 90-day mortality was explored using Lasso regression. Whole-genome sequencing of bacterial isolates was used for emm typing and virulence gene profiling. Results The 126 GAS NSTI cases and 27 cases caused by SD constituted 31% and 7% of the whole NSTI cohort, respectively. When comparing to nonnecrotizing streptococcal cellulitis, streptococcal NSTI was associated to blunt trauma, absence of preexisting skin lesions, and a lower body mass index. Septic shock was significantly more frequent in GAS (65%) compared to SD (41%) and polymicrobial, nonstreptococcal NSTI (46%). Age, male sex, septic shock, and no administration of intravenous immunoglobulin (IVIG) were among factors associated with 90-day mortality. Predominant emm types were emm1, emm3, and emm28 in GAS and stG62647 in SD. Conclusions Streptococcal NSTI was associated with several risk factors, including blunt trauma. Septic shock was more frequent in NSTI caused by GAS than in cases due to SD. Factors associated with mortality in GAS NSTI included age, septic shock, and no administration of IVIG.

Necrotizing Soft-Tissue Infections in the Feet of Patients With Diabetes: Outcome of Surgical Treatment and Factors Associated With Limb Loss and Mortality

2009 ◽  
Vol 8 (3) ◽  
pp. 141-146 ◽  
Author(s):  
Javier Aragón-Sánchez ◽  
Yurena Quintana-Marrero ◽  
Jose L. Lázaro-Martínez ◽  
Maria J. Hernández-Herrero ◽  
Esther García-Morales ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Limb Loss ◽  
Soft Tissue Infections ◽  
Factors Associated ◽  
Patients With Diabetes ◽  
Necrotizing Soft Tissue Infections ◽  
Diabetes Outcome

scholarly journals Necrotizing Soft Tissue Infections in Intensive Care

2021 ◽  
pp. 088506662110101
Author(s):  
Alexandru Ogica ◽  
Christoph Burdelski ◽  
Holger Rohde ◽  
Stefan Kluge ◽  
Geraldine de Heer
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
Soft Tissue ◽  
Sofa Score ◽  
Laboratory Data ◽  
Serum Lactate ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections ◽  
The Mean ◽  
Organ Dysfunctions

Background: Necrotizing soft tissue infections (NSTIs) are typically characterized by extensive soft tissue destruction with systemic signs of toxicity, ranging from sepsis to septic shock. Our aim was to analyze the clinical characteristics, microbiological results, laboratory data, therapies, and outcome of patients with NSTIs admitted to an intensive care unit (ICU). Methods: A monocentric observational study of patients admitted to the ICU of a university hospital between January 2009 and December 2017. The demographic characteristics, comorbidities, clinical features, microbiology and laboratory results, organ dysfunctions, therapies, and outcome were retrospectively analyzed. Results: There were 59 patients and 70% males. The mean age (± SD) was 55 ± 18; type II (monomicrobial) NSTI was present in 36 patients (61%); the most common isolated pathogen was Streptococcus pyogenes in 28 patients (48%). Septic shock was diagnosed in 41 patients (70%). The most common organ dysfunctions were circulatory and renal in 42 (71%) and 38 patients (64%). The mean value (± SD) of serum lactate at admission to the ICU was 4.22 ± 5.42 mmol/l, the median SOFA score and SAPS II were 7 (IQR 4 - 10) and 46 (IQR 30.5 - 53). ICU mortality rate was 25%. Both SOFA score and serum lactate demonstrated a good prognostic value regarding ICU outcome (OR 1.29, 95%CI 1.07-1.57, P < 0.007 and OR 1.53, 95%CI 1.19-1.98, P < 0.001). A cut-off value for serum lactate of 6.55 mmol/L positively predicted mortality with 67% sensitivity and 97% specificity. Conclusion: NSTIs carry a high risk of septic shock and multiple organ dysfunction syndrome and thus are still associated with high mortality. In our study, the value of serum lactate at admission to the ICU correlated well with mortality. This easy-to-measure parameter could play a role in the decision-making process regarding prognosis and continuation of care.

#31: Risk Factors Associated with Mortality due to Multidrug-Resistant Organisms in Pediatric Oncology Patients with Febrile Neutropenia

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S15-S16
Author(s):  
Miguel A Minero ◽  
Asia Castro ◽  
Martha Avilés-Robles
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Pediatric Patients ◽  
Bloodstream Infections ◽  
Oncology Patients ◽  
Factors Associated ◽  
Patients With Cancer ◽  
The Impact

Abstract Background Infectious processes are frequent complications presented in pediatric patients with cancer. Currently, the indiscriminate use of antibiotics induces resistance to available treatments, creating the emergence of multi-drug-resistant organisms (MDROs). Due to the impact in morbidity and mortality secondary to MDRO infection, we aimed to identify risk factors associated with mortality in infections due to MDROs in pediatric patients with cancer. Methods Case–control study nested in a prospective cohort of pediatric oncology patients with febrile neutropenia (FN) at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from March 2015 to September 2017. MDRO was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Patients with FN episodes who died from an infection due to MDROs were defined as cases and patients with FN episodes of an infection due to MDROs who did not die were defined as controls. Mucositis, septic shock, PICU stay, and bacterial prophylaxis (Trimethoprim/Sulfamethoxazole) were compared between groups. Descriptive statistics was performed and Pearson χ 2 or Student’s t-test were used to compare risk factors between groups. Results A total of 929 FN episodes were documented, 44.4% episodes occurred in male patients, mean age was 7.9 years, with the population under 5 years being the most represented (68.2%). The most frequent diagnosis was acute lymphoblastic leukemia in 75% followed by rhabdomyosarcoma in 10.5% and acute myeloid leukemia in 9.6%. Prophylaxis (trimethoprim/sulfamethoxazole) was used in 86%, mucositis was present in 9.2% of episodes. 12.1% had septic shock and 4.7% were admitted to PICU. In 148 FN episodes (15.9%) a microorganism was identified, of these 50 (33.7%) were due to an MDROs. Urinary tract infection was the most frequent site (49%), followed by bloodstream infections (47%). K. pneumoniae was the most frequent MDRO in 22.8%, followed by E. coli in 19.2% and P. aeruginosa in 14%. Septic shock was presented in 26% of MDROs infections. Overall mortality was 1.94% and only 0.86% (8) were secondary to MDROs. Of patients with MDRO isolated mortality was 30% (15/50). Mortality associated with bloodstream infection due to MDROs was 25% compared with other source of MDROs infections (3%) (P = 0.01). Septic shock was present in 40% of patients with death due to MDROs infection (P = 0.001). Conclusions In our population of children with FN episodes who had an isolated microorganism, infection due to MDROs are high (33.7%) and MDROs infection-directed mortality was as high as 30%. Bloodstream infections and septic shock were risk factors associated with mortality due to MDROs.

scholarly journals Factors Associated with Mortality and Amputation Caused by Necrotizing Soft Tissue Infections of the Upper Extremity: A Retrospective Cohort Study

2019 ◽  
Vol 44 (3) ◽  
pp. 730-740 ◽  
Author(s):  
Femke Nawijn ◽  
Svenna H.W.L. Verhiel ◽  
Kiera N. Lunn ◽  
Kyle R. Eberlin ◽  
Falco Hietbrink ◽  
...  
Keyword(s):  
Risk Factor ◽  
Soft Tissue ◽  
Mortality Rate ◽  
Upper Extremity ◽  
Base Deficit ◽  
Amputation Rate ◽  
Soft Tissue Infections ◽  
Factors Associated ◽  
Asa Classification ◽  
Necrotizing Soft Tissue Infections

Abstract Background It is unclear what the exact short-term outcomes of necrotizing soft tissue infections (NSTIs), also known and necrotizing fasciitis of the upper extremity, are and whether these are comparable to other anatomical regions. Therefore, the aim of this study is to assess factors associated with mortality within 30-days and amputation in patients with upper extremity NSTIs. Methods A retrospective study over a 20-year time period of all patients treated for NSTIs of the upper extremity was carried out. The primary outcomes were the 30-day mortality rate and the amputation rate in patients admitted to the hospital for upper extremity NSTIs. Results Within 20 years, 122 patients with NSTIs of the upper extremity were identified. Thirteen patients (11%) died and 17 patients (14%) underwent amputation. Independent risk factors for mortality were an American Society of Anesthesiologists (ASA) classification of 3 or higher (OR 9.26, 95% CI 1.64–52.31) and a base deficit of 3 meq/L or greater (OR 10.53, 95% CI 1.14–96.98). The independent risk factor for amputation was a NSTI of the non-dominant arm (OR 3.78, 95% CI 1.07–13.35). Length of hospital stay was 15 (IQR 9–21) days. Conclusion Upper extremity NSTIs have a relatively low mortality rate, but a relatively high amputation rate compared to studies assessing NSTIs of all anatomical regions. ASA classification and base deficit at admission predict the prognosis of patients with upper extremity NSTIs, while a NSTI of the non-dominant side is a risk factor for limb loss.

Estimating the Impact of Necrotizing Soft Tissue Infections in the United States: Incidence and Re-Admissions

2020 ◽  
Author(s):  
Addison K. May ◽  
Victor B. Talisa ◽  
David A. Wilfret ◽  
Eileen Bulger ◽  
Wayne Dankner ◽  
...  
Keyword(s):  
United States ◽  
Soft Tissue ◽  
The United States ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections ◽  
The Impact

The Impact of Diabetes in Patients with Necrotizing Soft Tissue Infections

2005 ◽  
Vol 6 (4) ◽  
pp. 427-438 ◽  
Author(s):  
Lillian S. Kao ◽  
Matthew T. Knight ◽  
Kevin P. Lally ◽  
David W. Mercer
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections ◽  
The Impact

Mandatory Operative Re-Exploration after Initial Debridement of Necrotizing Soft Tissue Infections: Is it Mandatory?

2017 ◽  
Vol 83 (10) ◽  
pp. 1117-1121
Author(s):  
Lara H. Spence ◽  
Huan Yan ◽  
Ashkan Moazzez ◽  
Alexander Schwed ◽  
Jessica Keeley ◽  
...  
Keyword(s):  
Septic Shock ◽  
Soft Tissue ◽  
Clinical Examination ◽  
Source Control ◽  
Soft Tissue Infections ◽  
Duration Of Symptoms ◽  
Safe Strategy ◽  
Necrotizing Soft Tissue Infections ◽  
Operative Debridement ◽  
Prompt Diagnosis

Necrotizing soft tissue infections (NSTIs) are aggressive infections requiring prompt diagnosis and extensive surgical debridement. Traditionally, patients undergo mandatory re-exploration to ensure adequacy of source control. The purpose of this study is to determine if re-exploration in the operating room is mandatory for all patients with NSTIs. An eight-year retrospective analysis of adult patients with NSTIs was performed comparing two groups: mandatory operative re-exploration versus operative re-exploration based on clinical examination findings. Outcomes measured included mortality, number of debridements, and length of stay (LOS). Twenty-two per cent of patients underwent a mandatory re-exploration. These patients were older, had a higher incidence of diabetes, and a longer duration of symptoms. There were no significant differences between groups with regard to the physical examination, severity of sepsis, time to repeat debridements, or in-hospital mortality, whereas LOS and the total number of debridements were increased in mandatory re-exploration. Bacteremia and septic shock were predictive of the need for further debridement in patients in the operative re-exploration based on clinical examination findings group. Mandatory re-exploration after initial debridement may not be necessary in all patients with NSTIs. Instead, bedside wound checks may be a safe strategy to determine the need for further operative debridement.

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