Abstract：
Background: Early debridement improves outcome in necrotizing soft tissue infection (NSTI), but there is no consensus on duration of antimicrobial therapy. We recently changed practice to discontinue antibiotic agents early with a goal of 48 hours after adequate source control. We hypothesized that discontinuing antibiotic agents after a short course is safe in the treatment of NSTI. Patients and Methods: This was a prospective study of patients with NSTI comparing short duration of antibiotic agents to a control population after a change in practice. In 2018 we began discontinuing antibiotic agents within 48 hours of source control (absence of cellulitis and no evidence of active infection). Previously, antibiotic duration was at the discretion of the attending surgeon (generally 7-10 days). Patients were excluded from analysis if they were initially debrided at a referring facility, immune compromised, or died prior to source control. Patient characteristics and outcomes were evaluated. The primary outcome was treatment failure requiring antibiotic agents to be restarted with or without further debridement of infected tissue. Secondary outcomes included the duration of antibiotic therapy after source control. Results: We evaluated 151 patients; 119 admitted between January 1, 2011 and January 31, 2018 (PRE) and 32 admitted after January 31, 2018 (POST). Patients were not statistically different regarding characteristics, admission physiologic variables, and comorbidities. The median duration of antibiotic agents after source control in the PRE group was 180.3 hours (interquartile range [IQR], 100.7-318.8) versus 48 hours (IQR, 32.3-100.8) in the POST group (p < 0.01). Patients in each group were treated as described above, and treatment failure occurred in seven (5.9%) PRE patients and two (6.3%) POST (99.3% post hoc power at non-inferiority limit 20%, significance p < 0.05). Thirty-day all-cause mortality was not different between groups (6.7% vs. 6.3%; p = 0.94). Conclusions: Short-duration (48 hours) antibiotic agents after NSTI source control is as safe and effective as a longer course.
摘要：
背景：早期清创可改善坏死性软组织感染（NSTI）的预后，但对于抗菌治疗的持续时间尚无共识.我们最近改变了做法，尽早停止抗生素治疗，目标是在进行适当的来源控制后48小时。我们假设在短期疗程后停用抗生素治疗NSTI是安全的。患者和方法：这是一项针对NSTI患者的前瞻性研究，在实践改变后将短期抗生素药物与对照人群进行了比较。2018年，我们在源头控制48小时内开始停用抗生素药物（无蜂窝织炎，无活动性感染证据）。以前,抗生素治疗持续时间由主治医师自行决定(一般为7~10天).如果患者最初在转诊机构清创，则将其排除在分析之外。免疫力受损，或者在源代码控制之前死亡。评估患者特征和结果。主要结果是治疗失败，需要在有或没有进一步清创感染组织的情况下重新启动抗生素。次要结果包括来源控制后抗生素治疗的持续时间。结果：我们评估了151例患者；2011年1月1日至2018年1月31日（PRE）期间收治的119例，2018年1月31日（POST）之后收治的32例。患者在特征方面没有统计学差异，入院生理变量，和合并症。在PRE组中，在源控制后抗生素药物的中位持续时间为180.3小时（四分位距[IQR]，100.7-318.8）与48小时（IQR，POST组的32.3-100.8）（p<0.01）。每组患者如上所述进行治疗，治疗失败发生在7例（5.9％）前患者和2例（6.3％）后（在非劣效性极限20％时，显著性p<0.05)。30天全因死亡率在组间没有差异(6.7%vs.6.3%；p=0.94）。结论：NSTI源控制后的短期（48小时）抗生素药物与更长的疗程一样安全有效。
