Patient’s characteristics and outcomes in necrotising soft-tissue infections: results from a Scandinavian, multicentre, prospective cohort study
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Patient’s characteristics and outcomes in necrotising soft-tissue infections : results from a Scandinavian, multicentre, prospective cohort study. / 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.; INFECT Study Group; Norrby-Teglund, Anna; Hyldegaard, Ole.
In: Intensive Care Medicine, Vol. 45, 2019, p. 1241-1251.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Patient’s characteristics and outcomes in necrotising soft-tissue infections
T2 - results from a Scandinavian, multicentre, prospective cohort study
AU - Madsen, Martin Bruun
AU - Skrede, Steinar
AU - Perner, Anders
AU - Arnell, Per
AU - Nekludov, Michael
AU - Bruun, Trond
AU - Karlsson, Ylva
AU - Hansen, Marco Bo
AU - Polzik, Peter
AU - Hedetoft, Morten
AU - Rosén, Anders
AU - Saccenti, Edoardo
AU - Bergey, François
AU - Martins dos Santos, Vitor A.P.
AU - INFECT Study Group
AU - Norrby-Teglund, Anna
AU - Hyldegaard, Ole
PY - 2019
Y1 - 2019
N2 - 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.
AB - 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.
KW - Critical care
KW - Fournier’s gangrene
KW - Group A streptococcus
KW - Necrotising fasciitis
KW - Sepsis
U2 - 10.1007/s00134-019-05730-x
DO - 10.1007/s00134-019-05730-x
M3 - Journal article
C2 - 31440795
AN - SCOPUS:85071306403
VL - 45
SP - 1241
EP - 1251
JO - European Journal of Intensive Care Medicine
JF - European Journal of Intensive Care Medicine
SN - 0935-1701
ER -
ID: 231642254