PDF(Pubmed)
Abstract：
Background: Early initiation of broad-spectrum antibiotic agents is a cornerstone of the care of necrotizing skin and soft tissue infections (NSTI). However, the optimal duration of antibiotic agents is unclear. We sought to characterize antibiotic prescribing patterns for patients with NSTI, as well as associated complications. Patients and Methods: Using an NSTI registry, we characterized antibiotic use at a quaternary referral center. Kaplan-Meier analyses were used to describe overall antibiotic duration and relative to operative source control, stratified by presence of other infections that independently influenced antibiotic duration. Factors associated with successful antibiotic discontinuation were identified using logistic regression. Results: Between 2015 and 2018, 441 patients received antibiotic agents for NSTI with 18% experiencing a complicating secondary infection. Among those without a complicating infection, the median duration of antibiotic administration was 9.8 days (95% confidence interval [CI], 9.2-10.5) overall, and 7.0 days after the final debridement. Perineal NSTI received fewer days of antibiotic agents (8.3 vs. 10.6) compared with NSTI without perineal involvement. White blood cell (WBC) count and fever were not associated with failure of antibiotic discontinuation, however, a chronic wound as the underlying infection etiology was associated with greater odds of antibiotic discontinuation failure (odds ratio [OR], 4.33; 95% CI, 1.24-15.1). Conclusions: A seven-day course of antibiotic agents after final operative debridement may be sufficient for NSTI without any secondary complicating infections, because clinical characteristics do not appear to be associated with differences in successful antibiotic discontinuation.
摘要：
背景：早期使用广谱抗生素是治疗坏死性皮肤和软组织感染（NSTI）的基石。然而,抗生素药物的最佳使用期限尚不清楚.我们试图描述NSTI患者的抗生素处方模式，以及相关的并发症。患者和方法：使用NSTI注册表，我们在四级转诊中心对抗生素使用情况进行了表征.Kaplan-Meier分析用于描述总体抗生素持续时间和相对于手术源控制，通过存在独立影响抗生素持续时间的其他感染进行分层。使用逻辑回归确定与成功停用抗生素相关的因素。结果：在2015年至2018年之间，441名患者接受了NSTI抗生素治疗，其中18％的患者经历了复杂的继发感染。在那些没有复杂感染的人中，抗生素给药的中位持续时间为9.8天(95%置信区间[CI]，9.2-10.5)总体，最后清创术后7.0天。会阴NSTI接受抗生素治疗的天数较少（8.3vs.10.6）与无会阴受累的NSTI相比。白细胞（WBC）计数和发热与抗生素停药失败无关，然而,作为潜在感染病因的慢性伤口与抗生素停药失败的几率更大(比值比[OR],4.33；95%CI，1.24-15.1）。结论：最终手术清创术后7天的抗生素疗程可能足以用于NSTI，而没有任何继发的并发症感染。因为临床特征似乎与成功停用抗生素的差异无关。
