Abstract：
BACKGROUND: Necrotizing skin and soft tissue infections (NSTIs) are rare but serious and rapidly progressive infections characterized by necrosis of subcutaneous tissue, fascia and even muscle. The care pathway of patients with NSTIs is poorly understood. A better characterization of the care trajectory of these patients and a better identification of patients at risk of a complicated evolution, requiring prolonged hospitalization, multiple surgical re-interventions, or readmission to the intensive care unit (ICU), is an essential prerequisite to improve their care. The main objective of this study is to obtain large-scale data on the care pathway of these patients. We performed a retrospective multicenter observational cohort study in 13 Great Paris area hospitals, including patients hospitalized between January 1, 2015 and December 31, 2019 in the ICU for surgically confirmed NSTIs.
RESULTS: 170 patients were included. The median duration of stay in ICU and hospital was 8 (3-17) and 37 (14-71) days, respectively. The median time from admission to first surgical debridement was 1 (0-2) day but 69.9% of patients were re-operated with a median of 1 (0-3) additional debridement. Inter-hospital transfer was necessary in 52.4% of patients. 80.2% of patients developed organ failures during the course of ICU stay with 51.8% of patients requiring invasive mechanical ventilation, 77.2% needing vasopressor support and 27.7% renal replacement therapy. In-ICU and in-hospital mortality rates were 21.8% and 28.8%, respectively. There was no significant difference between patients with abdomino-perineal NSTIs (n = 33) and others (n = 137) in terms of in-hospital or ICU mortality. Yet, immunocompromised patients (n = 43) showed significantly higher ICU and in-hospital mortality rates than non-immunocompromised patients (n = 127) (37.2% vs. 16.5%, p = 0.009, and 53.5% vs. 20.5%, p < 0.001). Factors associated with a complicated course were the presence of a polymicrobial infection (adjusted odds ratio [aOR = 3.18 (1.37-7.35); p = 0.007], of a bacteremia [aOR = 3.29 (1.14-9.52); p = 0.028] and a higher SAPS II score [aOR = 1.05 (1.02-1.07); p < 0.0001]. 62.3% of patients were re-hospitalized within 6 months.
CONCLUSIONS: In this retrospective multicenter study, we showed that patients with NSTI required complex management and are major consumers of care. Two-thirds of them underwent a complicated hospital course, associated with a higher SAPS II score, a polymicrobial NSTI and a bacteremia.
RESULTS: 170 patients were included. The median duration of stay in ICU and hospital was 8 (3-17) and 37 (14-71) days, respectively. The median time from admission to first surgical debridement was 1 (0-2) day but 69.9% of patients were re-operated with a median of 1 (0-3) additional debridement. Inter-hospital transfer was necessary in 52.4% of patients. 80.2% of patients developed organ failures during the course of ICU stay with 51.8% of patients requiring invasive mechanical ventilation, 77.2% needing vasopressor support and 27.7% renal replacement therapy. In-ICU and in-hospital mortality rates were 21.8% and 28.8%, respectively. There was no significant difference between patients with abdomino-perineal NSTIs (n = 33) and others (n = 137) in terms of in-hospital or ICU mortality. Yet, immunocompromised patients (n = 43) showed significantly higher ICU and in-hospital mortality rates than non-immunocompromised patients (n = 127) (37.2% vs. 16.5%, p = 0.009, and 53.5% vs. 20.5%, p < 0.001). Factors associated with a complicated course were the presence of a polymicrobial infection (adjusted odds ratio [aOR = 3.18 (1.37-7.35); p = 0.007], of a bacteremia [aOR = 3.29 (1.14-9.52); p = 0.028] and a higher SAPS II score [aOR = 1.05 (1.02-1.07); p < 0.0001]. 62.3% of patients were re-hospitalized within 6 months.
CONCLUSIONS: In this retrospective multicenter study, we showed that patients with NSTI required complex management and are major consumers of care. Two-thirds of them underwent a complicated hospital course, associated with a higher SAPS II score, a polymicrobial NSTI and a bacteremia.
摘要：
背景：坏死性皮肤和软组织感染（NSTIs）是罕见但严重且快速进展的感染，其特征是皮下组织坏死，筋膜甚至肌肉。NSTIs患者的护理途径知之甚少。更好地表征这些患者的护理轨迹，更好地识别存在复杂演变风险的患者，需要长期住院，多次手术再干预，或重新进入重症监护病房(ICU)，是改善他们护理的必要前提。这项研究的主要目的是获得有关这些患者的护理途径的大规模数据。我们在大巴黎地区的13家医院进行了一项回顾性多中心观察队列研究，包括2015年1月1日至2019年12月31日因手术证实的NSTIs在ICU住院的患者.
结果：纳入170例患者。在ICU和医院的平均住院时间为8（3-17）和37（14-71）天，分别。从入院到首次手术清创的中位时间为1（0-2）天，但69.9％的患者再次手术，中位时间为1（0-3）次额外清创。52.4％的患者需要进行医院间转移。80.2%的患者在ICU期间出现器官衰竭，51.8%的患者需要有创机械通气，77.2％需要血管加压药支持和27.7％的肾脏替代治疗。ICU和院内死亡率分别为21.8%和28.8%,分别。在住院或ICU死亡率方面，腹部-会阴NSTIs患者（n=33）和其他患者（n=137）之间没有显着差异。然而，免疫功能低下患者（n=43）的ICU和院内死亡率明显高于非免疫功能低下患者（n=127）（37.2%vs.16.5%,p=0.009，53.5%与20.5%,p<0.001)。与复杂病程相关的因素是多重微生物感染的存在(调整后的比值比[aOR=3.18(1.37-7.35);p=0.007],菌血症[aOR=3.29(1.14-9.52);p=0.028]和更高的SAPSII评分[aOR=1.05(1.02-1.07);p<0.0001]。62.3%的患者在6个月内再次住院。
结论：在这项回顾性多中心研究中，我们发现NSTI患者需要复杂的管理,并且是主要的医疗消费者.其中三分之二的人接受了复杂的医院治疗，与更高的SAPSII评分相关，多微生物NSTI和菌血症。
结果：纳入170例患者。在ICU和医院的平均住院时间为8（3-17）和37（14-71）天，分别。从入院到首次手术清创的中位时间为1（0-2）天，但69.9％的患者再次手术，中位时间为1（0-3）次额外清创。52.4％的患者需要进行医院间转移。80.2%的患者在ICU期间出现器官衰竭，51.8%的患者需要有创机械通气，77.2％需要血管加压药支持和27.7％的肾脏替代治疗。ICU和院内死亡率分别为21.8%和28.8%,分别。在住院或ICU死亡率方面，腹部-会阴NSTIs患者（n=33）和其他患者（n=137）之间没有显着差异。然而，免疫功能低下患者（n=43）的ICU和院内死亡率明显高于非免疫功能低下患者（n=127）（37.2%vs.16.5%,p=0.009，53.5%与20.5%,p<0.001)。与复杂病程相关的因素是多重微生物感染的存在(调整后的比值比[aOR=3.18(1.37-7.35);p=0.007],菌血症[aOR=3.29(1.14-9.52);p=0.028]和更高的SAPSII评分[aOR=1.05(1.02-1.07);p<0.0001]。62.3%的患者在6个月内再次住院。
结论：在这项回顾性多中心研究中，我们发现NSTI患者需要复杂的管理,并且是主要的医疗消费者.其中三分之二的人接受了复杂的医院治疗，与更高的SAPSII评分相关，多微生物NSTI和菌血症。
