Trends and Factors Associated with Initial and Recurrent Methicillin-ResistantStaphylococcus aureus(MRSA) Skin and Soft-Tissue Infections among HIV-Infected Persons

2013 ◽  
Vol 13 (3) ◽  
pp. 206-213 ◽  
Author(s):  
Kartavya J. Vyas ◽  
Aladdin H. Shadyab ◽  
Chii-Dean Lin ◽  
Nancy F. Crum-Cianflone
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infections ◽  
Factors Associated

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 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.

Comparative Analysis of Empiric Antimicrobial Treatments for Skin and Soft Tissue Infections in Newly Hospitalized Patients

2013 ◽  
Vol 27 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Cyrus Yazdani ◽  
Nancy Hanna
Keyword(s):  
Soft Tissue ◽  
Statistical Significance ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Group Differences ◽  
Soft Tissue Infections ◽  
Vancomycin Therapy ◽  
Factors Associated ◽  
Complicated Skin ◽  
Antimicrobial Treatments

Purpose: Intravenous vancomycin is the standard empiric treatment for complicated skin and soft tissue infections (SSTIs) due to its coverage against methicillin-resistant Staphylococcus aureus (MRSA). The objective of this study was to compare the hospital length of stay (LOS) between vancomycin-treated patients and patients receiving newer anti-MRSA agents. The study also aimed to identify factors associated with therapy change in patients receiving vancomycin on admission. Methods: Electronic medical records were used to conduct this retrospective cohort study. The LOS was compared among 5 groups of adult patients with admission diagnoses for SSTI who were initiated on linezolid, daptomycin, ceftaroline, tigecycline, or vancomycin. Survival analysis was used to identify factors associated with therapy change from vancomycin to another study medication. Results: Vancomycin was prescribed in 1046 (92%) admissions. Although none of the between-group differences in LOS reached statistical significance, there was a trend toward shorter LOS in vancomycin-treated patients compared to linezolid-treated patients ( P = .059). Coagulopathy was independently associated with increased likelihood of therapy change from vancomycin (hazard ratio = 4.71; P <.001). Conclusions: In the treatment of SSTI, newer agents result in LOS comparable to vancomycin. In patients initiated on vancomycin, therapy change was associated with longer LOS. Coagulopathy was independently associated with increased probability of therapy change.

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.

scholarly journals Incidence and factors associated with emergency department visits for recurrent skin and soft tissue infections in patients in California, 2005–2011

2016 ◽  
Vol 145 (4) ◽  
pp. 746-754 ◽  
Author(s):  
L. MAY ◽  
E. Y. KLEIN ◽  
E. M. MARTINEZ ◽  
N. MOJICA ◽  
L. G. MILLER
Keyword(s):  
Emergency Department ◽  
Soft Tissue ◽  
Geographical Location ◽  
Risk Groups ◽  
Primary Diagnosis ◽  
Emergency Department Visits ◽  
Soft Tissue Infections ◽  
Discharge Data ◽  
Factors Associated ◽  
Ed Visits

SUMMARYMore than 2 million visits for skin and soft tissue infections (SSTIs) are seen in US emergency departments (EDs) yearly. Up to 50% of patients with SSTIs, suffer from recurrences, but associated factors remain poorly understood. We performed a retrospective study of patients with primary diagnosis of SSTI between 2005 and 2011 using California ED discharge data from the State Emergency Department Databases and State Inpatient Databases. Using a multivariable logistic regression, we examined factors associated with a repeat SSTI ED visits up to 6 months after the initial SSTI. Among 197 371 SSTIs, 16·3% were associated with a recurrent ED visit. We found no trend in recurrent visits over time (χ2 trend = 0·68, P = 0·4). Race/ethnicity, age, geographical location, household income, and comorbidities were all associated with recurrent visits. Recurrent ED visits were associated with drug/alcohol abuse or liver disease [odds ratio (OR) 1·4, 95% confidence interval (CI) 1·3–1·4], obesity (OR 1·3, 95% CI 1·2–1·4), and in infections that were drained (OR 1·1, 95% CI 1·1–1·1) and inversely associated with hospitalization after initial ED visit (OR 0·4, 95% CI 0·3–0·4). In conclusion, we found several patient-level factors associated with recurrent ED visits. Identification of these high-risk groups is critical for future ED-based interventions.

Factors associated with readmission and mortality in adult patients with skin and soft tissue infections

2019 ◽  
Vol 58 (8) ◽  
pp. 916-924 ◽  
Author(s):  
Manuel Raya‐Cruz ◽  
Antonio Payeras‐Cifre ◽  
Lola Ventayol‐Aguiló ◽  
Paz Díaz‐Antolín
Keyword(s):  
Soft Tissue ◽  
Adult Patients ◽  
Soft Tissue Infections ◽  
Factors Associated

Factors Associated with Mortality Following Burns Complicated by Necrotizing Skin and Soft Tissue Infections: A Systematic Review and Meta-analysis of Individual Participant Data

2021 ◽  
Author(s):  
Kevin M Klifto ◽  
Caresse F Gurno ◽  
Stella M Seal ◽  
C Scott Hultman
Keyword(s):  
Soft Tissue ◽  
Graft Survival ◽  
Burn Injury ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Individual Participant Data ◽  
Soft Tissue Infections ◽  
Factors Associated ◽  
Burn Center ◽  
Individual Participant

Abstract We reviewed studies with individual participant data of patients who sustained burn injury and subsequently developed necrotizing skin and soft tissue infections (NSTI). Characteristics and managements were compared between patients who lived and patients who died to determine factors associated with mortality. Six databases (PubMed, EMBASE, Cochrane Library, Web of Science, Scopus and CINAHL) were searched. PRISMA-IPD guidelines were followed throughout the review. Eligible patients sustained a burn injury, treated in any setting, and diagnosed with a NSTI following burn injury. Comparisons were made between burned patients who lived “non-mortality” and burned patients who died “mortality” following NSTI using non-parametric univariate analyses. Fifty-eight studies with 78 patients were published from 1970 through 2019. Non-mortality resulted in 58 patients and mortality resulted in 20 patients. Patients with mortality had significantly greater median %TBSA burned (45%[IQR:44-64%] versus 35%[IQR:11-59%],p=0.033), more intubations (79% versus 43%,p=0.013), less debridements (83% versus 98%,p=0.039), less skin excisions (83% versus 98%,p=0.039), more complications (100% versus 50%,p&lt;0.001), management at a burn center (100% versus 71%,p=0.008), underwent less flap surgeries (5% versus 35%,p=0.014), less graft survival (25% versus 86%,p&lt;0.001), and less healed wounds (5% versus 95%,p&lt;0.001), compared to patients with non-mortality, respectively. Non-mortality patients had more debridements, skin excised, systemic antimicrobials, skin graft survival, flaps, improvement following surgery and healed wounds compared to mortality patients. Mortality patients had greater %TBSA burned, intubations, management at a burn center and complications compared to non-mortality patients.

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