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

Martin Bruun Madsen; Steinar Skrede; Anders Perner; Per Arnell; Michael Nekludov; Trond Bruun; Ylva Karlsson; Marco Bo Hansen; Peter Polzik; Morten Hedetoft; Anders Rosén; Edoardo Saccenti; François Bergey; Vitor A.P. Martins dos Santos; INFECT Study Group; Anna Norrby-Teglund; Ole Hyldegaard

doi:10.1007/s00134-019-05730-x

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

Martin Bruun Madsen^*, Steinar Skrede, Anders Perner, Per Arnell, Michael Nekludov, Trond Bruun, Ylva Karlsson, Marco Bo Hansen, Peter Polzik, Morten Hedetoft, Anders Rosén, Edoardo Saccenti, François Bergey, Vitor A.P. Martins dos Santos, INFECT Study Group, Anna Norrby-Teglund, Ole Hyldegaard

^*Corresponding author af dette arbejde

Institut for Klinisk Medicin

27 Citationer (Scopus)

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.

Originalsprog	Engelsk
Tidsskrift	Intensive Care Medicine
Vol/bind	45
Sider (fra-til)	1241-1251
Antal sider	11
ISSN	0342-4642
DOI	https://doi.org/10.1007/s00134-019-05730-x
Status	Udgivet - 2019

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10.1007/s00134-019-05730-x

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Madsen, M. B., Skrede, S., Perner, A., Arnell, P., Nekludov, M., Bruun, T., Karlsson, Y., Hansen, M. B., Polzik, P., Hedetoft, M., Rosén, A., Saccenti, E., Bergey, F., Martins dos Santos, V. A. P., INFECT Study Group, Norrby-Teglund, A., & Hyldegaard, O. (2019). Patient’s characteristics and outcomes in necrotising soft-tissue infections: results from a Scandinavian, multicentre, prospective cohort study. Intensive Care Medicine, 45, 1241-1251. https://doi.org/10.1007/s00134-019-05730-x

Madsen, MB, Skrede, S, Perner, A, Arnell, P, Nekludov, M, Bruun, T, Karlsson, Y, Hansen, MB, Polzik, P, Hedetoft, M, Rosén, A, Saccenti, E, Bergey, F, Martins dos Santos, VAP, INFECT Study Group, Norrby-Teglund, A & Hyldegaard, O 2019, 'Patient’s characteristics and outcomes in necrotising soft-tissue infections: results from a Scandinavian, multicentre, prospective cohort study', Intensive Care Medicine, bind 45, s. 1241-1251. https://doi.org/10.1007/s00134-019-05730-x

@article{017baf4f4e694743bf54483c03bfd0cb,

title = "Patient{\textquoteright}s characteristics and outcomes in necrotising soft-tissue infections: results from a Scandinavian, multicentre, prospective cohort study",

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{\textquoteright}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{\textquoteright}s gangrene, Group A streptococcus, Necrotising fasciitis, Sepsis",

author = "Madsen, {Martin Bruun} and Steinar Skrede and Anders Perner and Per Arnell and Michael Nekludov and Trond Bruun and Ylva Karlsson and Hansen, {Marco Bo} and Peter Polzik and Morten Hedetoft and Anders Ros{\'e}n and Edoardo Saccenti and Fran{\c c}ois Bergey and {Martins dos Santos}, {Vitor A.P.} and {INFECT Study Group} and Anna Norrby-Teglund and Ole Hyldegaard",

year = "2019",

doi = "10.1007/s00134-019-05730-x",

language = "English",

volume = "45",

pages = "1241--1251",

journal = "European Journal of Intensive Care Medicine",

issn = "0935-1701",

publisher = "Springer",

}

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

SN - 0935-1701

VL - 45

SP - 1241

EP - 1251

JO - European Journal of Intensive Care Medicine

JF - European Journal of Intensive Care Medicine

ER -

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

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