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Multicenter Study
. 2019 Sep;45(9):1241-1251.
doi: 10.1007/s00134-019-05730-x. Epub 2019 Aug 22.

Patient's characteristics and outcomes in necrotising soft-tissue infections: results from a Scandinavian, multicentre, prospective cohort study

Martin Bruun Madsen  1 , Steinar Skrede  2   3 , Anders Perner  4   5 , Per Arnell  6 , Michael Nekludov  7 , Trond Bruun  2 , Ylva Karlsson  8 , Marco Bo Hansen  9 , Peter Polzik  9 , Morten Hedetoft  9 , Anders Rosén  6 , Edoardo Saccenti  10 , François Bergey  11 , Vitor A P Martins Dos Santos  10   11 ; INFECT study group; Anna Norrby-Teglund  12 , Ole Hyldegaard  5   9
Collaborators, Affiliations
Multicenter Study

Patient's characteristics and outcomes in necrotising soft-tissue infections: results from a Scandinavian, multicentre, prospective cohort study

Martin Bruun Madsen et al. Intensive Care Med. 2019 Sep.

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Critical care; Fournier’s gangrene; Group A streptococcus; Necrotising fasciitis; Sepsis.

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