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Multicenter Study
. 2025 Oct 28;51(1):321.
doi: 10.1007/s00068-025-03000-8.

Characteristics, treatments, and outcomes of patients with necrotizing soft tissue infections: a Dutch multicenter cohort study

Jesse de Haan  1   2   3 , Lidewij M F H Neeter  4 , Jaco Suijker  4 , Paul P M van Zuijlen  4   5   6   7   8 , Anouk Pijpe  4   5   6 , Annebeth Meij-de Vries  9   10   11 ; NSTI Knowledge Collaborative Group
Collaborators, Affiliations
Multicenter Study

Characteristics, treatments, and outcomes of patients with necrotizing soft tissue infections: a Dutch multicenter cohort study

Jesse de Haan et al. Eur J Trauma Emerg Surg. .

Abstract

Purpose: Necrotizing Soft Tissue Infections (NSTI) are associated with high mortality and morbidity. This study aimed to gain insights into the patient-, disease-, and treatment characteristics, as well as the clinical outcomes of NSTI patients in the Netherlands, contributing to the global knowledge of this disease.

Methods: This study analyzed the NSTI Knowledge Project cohort, comprising 271 patients who were treated for acute NSTI in 11 hospitals across the Netherlands between 2013 and 2017.

Results: Most patients (61%) presented with early-stage NSTI symptoms, such as pain or erythema. Intensive care unit admission was required in 83%, with a median stay of 5 days (interquartile range 2-11). The median time from hospital admission to debridement was 8 h (interquartile range 4-23). Group A Streptococcus was cultured in 41% of patients. Extremity amputation was required in 12%, and the in-hospital mortality rate was 21%. Patients presenting with early-stage symptoms who were misdiagnosed (60%) had a significantly higher in-hospital mortality rate (30%) than those correctly diagnosed (10%; p = .003).

Conclusion: In the Netherlands, NSTI patient and disease characteristics vary considerably. With one in five patients dying and one in eight patients undergoing a major amputation, interventions leading to rapid diagnosis and treatment are urgently needed.

Keywords: Amputation; Group A Streptococcus; Mortality; Necrotizing fasciitis; Necrotizing soft tissue infection.

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Conflict of interest statement

Declarations. Ethics approval: The medical research ethics committee of Amsterdam University Medical Centre determined that our study was not subject to the Medical Research Involving Human Subjects Act (WMO). Consent to participate: Not applicable. Consent to publish: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Prevalence of symptom combinations at hospital presentation. Dots connected by lines (A) below the bars illustrate which symptoms are present in each combination. The bar height (B) indicates the number of cases with each symptom combination. The set size (C) displays the number of cases that presented with each symptom. Symptom combinations that were present in fewer than three cases were excluded. There was missing data for 13 cases (4.8%) except for the variable fever, for which there was missing data for 17 cases (6.3%)
Fig. 2
Fig. 2
Cultured pathogens and antibiotics used in monomicrobial NSTI. The most commonly administered antibiotic combinations and individual antibiotics following the working diagnosis of monomicrobial NSTI are presented separately for the three most common pathogens. Only the three most common antibiotics and antibiotic combinations are reported. Combinations used in only one patient were excluded. aMissing values refer to antibiotic data, not pathogen identification
Fig. 3
Fig. 3
Cultured pathogens and antibiotics used in polymicrobial NSTI. There was missing data regarding antibiotic use for 7 cases (5.9%). Only the three most common antibiotics and antibiotic combinations were reported. Clindamycin was the most frequently used antibiotic overall, but was administered in a wide variety of combinations
See this image and copyright information in PMC

References

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