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. 2019 Oct 24;9(1):123.
doi: 10.1186/s13613-019-0598-4.

Impact of a multidisciplinary care bundle for necrotizing skin and soft tissue infections: a retrospective cohort study

Tomas Urbina  1 , Camille Hua  2   3 , Emilie Sbidian  2   3   4 , Romain Bosc  5 , Françoise Tomberli  6 , Raphael Lepeule  7   8 , Jean-Winoc Decousser  3   8   9 , Armand Mekontso Dessap  1   3   10 , Olivier Chosidow  2   3   9 , Nicolas de Prost  11   12   13 ; Henri Mondor Hospital Necrotizing Fasciitis group
Affiliations

Impact of a multidisciplinary care bundle for necrotizing skin and soft tissue infections: a retrospective cohort study

Tomas Urbina et al. Ann Intensive Care. .

Abstract

Background: Necrotizing skin and soft tissue infections (NSTIs) require both prompt medical and surgical treatment. The coordination of multiple urgent interventions by care bundles has improved outcome in other settings. This study aimed to assess the impact of a multidisciplinary care bundle on management and outcome of patients with NSTIs.

Methods: Patients with NSTIs admitted between 2006 and 2017 were compared according to admission before or after bundle implementation (2012-2013). This bundle consisted mainly in (1) the creation of a multidisciplinary task force; (2) management guidelines on empirical antibiotics, intensive care unit admission criteria, a triage algorithm to accelerate operating room access; and (3) an active communication policy. Patient recruitment and management were compared between pre- and post-implementation periods. Main outcome was day 60-censored hospital survival.

Results: Overall, 224 patients were admitted: 60 before, 35 during, and 129 after bundle implementation. Admission after implementation was associated with increased yearly admissions (10 [8-13] vs 30 [24-43] patients/year, p = 0.014) and decreased mortality (30 vs 15%, HR = 0.49 [0.26-0.92]; p = 0.026) but was no longer a protective factor for mortality after adjustment on confounding factors (adjusted HR = 0.90 [0.43-1.88], p = 0.780). There was no significant difference regarding time to surgery (0 [0-1] vs 0 [0-1] days, p = 0.192) or rate of antibiotic treatment within 24 h (98% vs 99%, p > 0.99).

Conclusions: Implementation of a multidisciplinary care bundle for NSTIs was feasible, but in a retrospective study from an already experienced center was not associated with significantly increased survival after adjustment.

Keywords: Mortality; Multidisciplinary management; Necrotizing fasciitis; Necrotizing skin and soft tissue infections; Patient care bundles; Time to debridement.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Yearly admissions to our center for necrotizing soft tissue infections (dotted line). The grayed area represents the implementation period of our bundle of care. p value for a Mann–Whitney test comparing yearly admissions for NSTI between the pre- and post-implementation periods
Fig. 2
Fig. 2
Kaplan–Meier survival curves comparing patients admitted during the pre- (blue line) and post- (red line) bundle of care implementation periods. p value comes from an unadjusted log rank test. Survival was censored at 60 days
Fig. 3
Fig. 3
Impact of the implementation of a multimodal bundle of care on pre-defined patient management outcomes. Patients from the pre- (blue histograms) and post-implementation (red histograms) periods are compared. None of the comparisons yielded statistically different results by Fisher’s exact test or the Chi-squared test according to sample size
See this image and copyright information in PMC

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