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- Title
Patient's characteristics and outcomes in necrotising soft-tissue infections: results from a Scandinavian, multicentre, prospective cohort study.
- Authors
Madsen, Martin Bruun; Skrede, Steinar; Perner, Anders; Arnell, Per; Nekludov, Michael; Bruun, Trond; Karlsson, Ylva; Hansen, Marco Bo; Polzik, Peter; Hedetoft, Morten; Rosén, Anders; Saccenti, Edoardo; Bergey, François; Martins dos Santos, Vitor A. P.; Norrby-Teglund, Anna; Hyldegaard, Ole; INFECT study group
- Abstract
<bold>Purpose: </bold>Necrotising soft-tissue infections (NSTI) are characterised by necrosis, fast progression, and high rates of morbidity and mortality, but our knowledge is primarily derived from small prospective studies and retrospective studies.<bold>Methods: </bold>We performed an international, multicentre, prospective cohort study of adults with NSTI describing patient's characteristics and associations between baseline variables and microbiological findings, amputation, and 90-day mortality.<bold>Results: </bold>We included 409 patients with NSTI; 402 were admitted to the ICU. Cardiovascular disease [169 patients (41%)] and diabetes [98 (24%)] were the most common comorbidities; 122 patients (30%) had no comorbidity. Before surgery, bruising of the skin [210 patients (51%)] and pain requiring opioids [172 (42%)] were common. The sites most commonly affected were the abdomen/ano-genital area [140 patients (34%)] and lower extremities [126 (31%)]. Monomicrobial infection was seen in 179 patients (44%). NSTI of the upper or lower extremities was associated with monomicrobial group A streptococcus (GAS) infection, and NSTI located to the abdomen/ano-genital area was associated with polymicrobial infection. Septic shock [202 patients (50%)] and acute kidney injury [82 (20%)] were common. Amputation occurred in 22% of patients with NSTI of an extremity and was associated with higher lactate level. All-cause 90-day mortality was 18% (95% CI 14-22); age and higher lactate levels were associated with increased mortality and GAS aetiology with decreased mortality.<bold>Conclusions: </bold>Patients with NSTI were heterogeneous regarding co-morbidities, initial symptoms, infectious localisation, and microbiological findings. Higher age and lactate levels were associated with increased mortality, and GAS infection with decreased mortality.
- Subjects
TRAUMATIC amputation; LONGITUDINAL method; COHORT analysis; SEPTIC shock; FOURNIER gangrene; LEG; LEG amputation
- Publication
Intensive Care Medicine, 2019, Vol 45, Issue 9, p1241
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-019-05730-x