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.

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.

Management of necrotizing soft tissue infections in the intensive care unit: results of an international survey

2015 ◽  
Vol 41 (8) ◽  
pp. 1506-1508 ◽  
Author(s):  
Nicolas de Prost ◽  
◽  
Emilie Sbidian ◽  
Olivier Chosidow ◽  
Christian Brun-Buisson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Soft Tissue ◽  
Soft Tissue Infections ◽  
International Survey ◽  
Necrotizing Soft Tissue Infections

Understanding necrotizing soft tissue infections in the intensive care unit

2020 ◽  
Vol 46 (9) ◽  
pp. 1739-1742 ◽  
Author(s):  
Tomas Urbina ◽  
Martin Bruun Madsen ◽  
Nicolas de Prost
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Soft Tissue ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections

scholarly journals Necrotizing soft-tissue infections in pediatric intensive care: a prospective multicenter case-series study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Stéphane Dauger ◽  
◽  
Renaud Blondé ◽  
Olivier Brissaud ◽  
Marie-Odile Marcoux ◽  
...  
Keyword(s):  
Intensive Care ◽  
Soft Tissue ◽  
Case Series ◽  
Pediatric Intensive Care ◽  
Soft Tissue Infections ◽  
Case Series Study ◽  
Necrotizing Soft Tissue Infections ◽  
Series Study

scholarly journals Utility of modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score in distinguishing necrotizing from non-necrotizing soft tissue infections

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Po-Han Wu ◽  
Kai-Hsiang Wu ◽  
Cheng-Ting Hsiao ◽  
Shu-Ruei Wu ◽  
Chia-Peng Chang
Keyword(s):  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Area Under The Curve ◽  
High Sensitivity ◽  
Serum Lactate ◽  
Receiver Operating Curve ◽  
Risk Indicator ◽  
Soft Tissue Infections ◽  
Laboratory Findings ◽  
Necrotizing Soft Tissue Infections

Abstract Background We conducted this study to promote a modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score and evaluate the utility in distinguishing necrotizing fasciitis (NF) from other soft-tissue infections. Method A retrospective cohort study of hospitalized patients with NF diagnosed by surgical finding was conducted in two tertiary hospital in southern Taiwan between January 2015 and January 2020. Another group was matched by controls with non-necrotizing soft tissue infections based on time, demographics, and immune status. Data such as infectious location, comorbidities, and laboratory findings were recorded and compared. Logistics regression were used to determine the association with NF after adjustment for confounders and MLRINEC score was developed by then. Receiver operating curve (ROC) and the area under the curve (AUC) were used to evaluate its discriminating ability. Result A total of 303 patients were included; 101 in NF group and 202 in non-NF group. We added serum lactate and comorbid liver disease to the original LRINEC score and re-defined the cut-off values for 3 variables to develop the MLRINEC score. The cut-off value for MLRINEC score was 12 points with corresponding sensitivity of 91.8% and a specificity of 88.4%, and the area under ROC (AUC) was 0.893 (95% CI, 0.723 to 0.948; p < 0.01). Conclusion MLRINEC score shows a high sensitivity and specificity in distinguishing NF from non-necrotizing soft-tissue infections. Patients with a MLRINEC score > 12 points should be highly suspected of presence of necrotizing fasciitis.

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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