451. High Rates of Hospitalization due to Skin and Soft-Tissue Infections in a Southwest American Indian Population

Abstract Background Skin and soft-tissue infections (SSTIs) involve the skin, subcutaneous tissue, fascia, or muscle. Hospitalizations due to SSTIs represent a significant health disparity for American Indians (AI), but specific literature is limited. We characterized SSTI hospitalizations at our critical access hospital that exclusively serves an AI population in the American Southwest. Methods We identified patients hospitalized (admitted or transferred) with an SSTI from June 2017 to May 2018. Relevant cases underwent chart extraction for demographics, SSTI characteristics, laboratory and microbiologic data, relevant history and co-morbidities. All variables were summarized using descriptive statistics. Odds ratios and P-values with two-tailed tests were used to identify risk factors for multiple SSTI episodes. Results During the study period, 289 unique individuals comprised 343 SSTI hospitalizations / episodes (18% of the 1,883 total hospitalizations). The unadjusted annual rate of SSTI hospitalization was 2,018 per 100,000. There were 13 cases of necrotizing fasciitis (NF) with an unadjusted rate of 76 per 100,000 per year. Only 183 episodes (53%) had a wound culture performed, with 84% positive for a pathogenic organism, compared with 287 episodes (84%) with a blood culture performed, of which only 7% were positive for a pathogen. Methicillin-resistant Staphylococcus aureus (MRSA), methicillin-sensitive SA (MSSA)and/or Streptococcus pyogenes accounted for 74.9% (n = 125) and co-infection with these three organisms accounted for 22.2% (n = 37) of positive wound cultures (n = 167). An SSTI in the last year (49%), diabetes (41.9%), alcohol abuse (40%) and hypertension (39%) were common among all 289 individuals. Diabetes (OR 3.3, P < 0.01), hypertension (OR 2.8, P < 0.01), renal disease (OR 2.7, P < 0.05), previous SSTI (OR 3.0, P < 0.01) were associated with a higher risk of multiple SSTI hospitalizations. Conclusion The incidence rate of SSTI hospitalization in this Southwest AI population was 9-times greater than the general US population and 4-times greater than prior reports in Southwest AI. The NF rate was >10-times the general US population rate. We describe common co-morbidities among these SSTI episodes and potential risk factors for repeat hospitalization. Disclosures All authors: No reported disclosures.

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Risk factors for methicillin-resistant Staphylococcus aureus skin and soft-tissue infections in outpatients in Taiwan

Epidemiology and Infection ◽

10.1017/s0950268814001642 ◽

2014 ◽

Vol 143 (4) ◽

pp. 749-753 ◽

Cited By ~ 7

Author(s):

Y.-H. CHOU ◽

M.-S. LEE ◽

R.-Y. LIN ◽

C.-Y. WU

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Soft Tissue ◽

Significant Risk ◽

Nasal Carriage ◽

Soft Tissue Infections ◽

Methicillin Resistant ◽

Asian Populations ◽

Appropriate Treatment ◽

Potential Risk Factors

SUMMARYInformation on the risk factors for community-associated skin and soft-tissue infections (SSTIs) due to methicillin-resistant Staphylococcus aureus in Asian populations is scarce. To this end we performed a case-control study of patients treated at two hospital-affiliated outpatient clinics in Taiwan to determine potential risk factors for MRSA SSTIs. S. aureus was isolated from 39 of 100 eligible patients, and 74% were MRSA. Apart from resistance to clindamycin and erythromycin, most MRSA isolates were susceptible to appropriate antimicrobials. The significant risk factors identified by multivariate analysis for MRSA SSTIs were male gender (P = 0·09), nasal carriage of MRSA (P = 0·02), exposure to an individual who had surgery within a year before infection (P = 0·02), and antibiotic treatment for SSTI in the year before infection (P = 0·04). The identification of such factors may assist provision of appropriate treatment to patients with suspected S. aureus SSTIs particularly in Taiwan.

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Noma and Necrotizing Fasciitis of the Face and Neck

Facial Plastic Surgery ◽

10.1055/s-0041-1722894 ◽

2021 ◽

Author(s):

Lauren E. Miller ◽

David A. Shaye

Keyword(s):

Soft Tissue ◽

Necrotizing Fasciitis ◽

Head And Neck ◽

Subcutaneous Tissue ◽

Neck Region ◽

Superficial Fascia ◽

Soft Tissue Infections ◽

Head And Neck Region ◽

Necrotizing Soft Tissue Infections ◽

The Face

AbstractNecrotizing fasciitis (NF) is part of the class of necrotizing soft tissue infections characterized by rapid fascial spread and necrosis of the skin, subcutaneous tissue, and superficial fascia. If left untreated, NF can rapidly deteriorate into multiorgan shock and systemic failure. NF most commonly infects the trunk and lower extremities, although it can sometimes present in the head and neck region. This review provides an overview of NF as it relates specifically to the head and neck region, including its associated clinical features and options for treatment. Noma, a related but relatively unknown disease, is then described along with its relationship with severe poverty.

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Soft Tissue Infection

10.2310/surg.2036 ◽

2019 ◽

Author(s):

Mark A. Malangoni ◽

Christopher R McHenry

Keyword(s):

Soft Tissue ◽

Soft Tissue Infection ◽

Toxic Shock Syndrome ◽

Bacterial Infections ◽

Subcutaneous Tissue ◽

Tissue Infection ◽

Soft Tissue Infections ◽

Toxic Shock ◽

Necrotizing Soft Tissue Infection ◽

Human Bites

Soft tissue infections are a diverse group of diseases that involve the skin and underlying subcutaneous tissue, fascia, or muscle. The authors review the diagnosis and management of the main soft tissue infections seen by surgeons, including both superficial infections and necrotizing infections. When the characteristic clinical features of necrotizing soft tissue infection are absent, diagnosis may be difficult. In this setting, laboratory and imaging studies become important. Studies emphasizes that computed tomography should continue to be used judiciously as an adjunct to clinical judgment. The delay between hospital admission and initial débridement is the most critical factor influencing morbidity and mortality. Once the diagnosis of necrotizing soft tissue infection is established, patient survival and soft tissue preservation are best achieved by means of prompt operation. Bacterial infections of the dermis and epidermis are covered in depth, along with animal and human bites. Methicillin-resistant Staphylococcus aureus (MRSA) accounts for up to 70% of all S. aureus infections acquired in the community and is the most common organism identified in patients presenting to the emergency department with a skin or soft tissue infection. The more classic findings associated with deep necrotizing infections—skin discoloration, the formation of bullae, and intense erythema—occur much later in the process. It is important to understand this point so that an early diagnosis can be made and appropriate treatment promptly instituted. The review’s discussion covers in depth the etiology and classification of soft tissue infection, pathogenesis of soft tissue infections, toxic shock syndrome, and reports on mortality from necrotizing soft tissue infection. This review 8 figures, 22 tables, and 58 references. Keywords: Erysipelas, cellulitis, soft tissue infection, necrotizing fasciitis, myonecrosis, toxic shock syndrome

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Staphylococcus aureus Colonisation in HIV-Infected Patients: Incidence, Risk Factors and Subsequent Skin- and Soft-Tissue Infections

Indian Journal of Medical Microbiology ◽

10.4103/ijmm.ijmm_20_5 ◽

2020 ◽

Vol 38 (3-4) ◽

pp. 444-447

Author(s):

Aashirwad Panigrahy ◽

Sanjeev Sinha ◽

Bimal Kumar Das ◽

Arti Kapil ◽

Sreenivas Vishnubhatla ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Soft Tissue ◽

Soft Tissue Infections ◽

Incidence Risk

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

Clinical Infectious Diseases ◽

10.1093/cid/ciaa027 ◽

2020 ◽

Cited By ~ 11

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.

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