Abstract：
BACKGROUND: Necrotizing soft tissue infections (NSTI) are increasing, posing a significant risk of morbidity and mortality. Due to nonspecific symptoms, a high index of suspicion is crucial. Treatment involves a multidisciplinary approach, with broad-spectrum antibiotics, early surgical debridement, and life support. This study analyzes the characteristics, demographics, complications, and treatment of NSTI in a hospital in Madrid, Spain.
METHODS: A retrospective observational study was conducted, including all surgically treated NSTI patients at our center from January 2016 to December 2022, examining epidemiological and clinical data. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) was prospectively calculated for all patients.
RESULTS: Twenty-two patients (16 men, 6 women, mean age 54.8) were included. Median time from symptom onset to emergency room visit was 3.5 days. All reported severe treatment-resistant pain; sixteen had fever exceeding 37.8°C (72.7%). Skin lesions occurred in twelve (54.5%), and thirteen had hypotension and tachycardia (59.1%). Treatment involved resuscitative support, antibiotherapy, and radical debridement. Median time to surgery was 8.25h. Intraoperative cultures were positive in twenty patients: twelve Streptococcus pyogenes, four Staphylococcus aureus, one Escherichia coli, and four polymicrobial infection. In-hospital mortality rate was 22.73%.
CONCLUSIONS: We examined the correlation between our results, amputation rates and mortality with LRINEC score and time to surgery. However, we found no significant relationship unlike some other studies. Nevertheless, a multidisciplinary approach with radical debridement and antibiotic therapy remains the treatment cornerstone. Our hospital stays, outcomes and mortality rates align with our literature review, confirming high morbimortality despite early and appropriate intervention.
METHODS: A retrospective observational study was conducted, including all surgically treated NSTI patients at our center from January 2016 to December 2022, examining epidemiological and clinical data. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) was prospectively calculated for all patients.
RESULTS: Twenty-two patients (16 men, 6 women, mean age 54.8) were included. Median time from symptom onset to emergency room visit was 3.5 days. All reported severe treatment-resistant pain; sixteen had fever exceeding 37.8°C (72.7%). Skin lesions occurred in twelve (54.5%), and thirteen had hypotension and tachycardia (59.1%). Treatment involved resuscitative support, antibiotherapy, and radical debridement. Median time to surgery was 8.25h. Intraoperative cultures were positive in twenty patients: twelve Streptococcus pyogenes, four Staphylococcus aureus, one Escherichia coli, and four polymicrobial infection. In-hospital mortality rate was 22.73%.
CONCLUSIONS: We examined the correlation between our results, amputation rates and mortality with LRINEC score and time to surgery. However, we found no significant relationship unlike some other studies. Nevertheless, a multidisciplinary approach with radical debridement and antibiotic therapy remains the treatment cornerstone. Our hospital stays, outcomes and mortality rates align with our literature review, confirming high morbimortality despite early and appropriate intervention.
摘要：
背景：坏死性软组织感染（NSTI）正在增加，构成发病率和死亡率的显著风险。由于非特异性症状，高度怀疑是至关重要的。治疗涉及多学科方法，使用广谱抗生素，早期手术清创,和生命支持。本研究分析了研究的特点，人口统计，并发症,在马德里的一家医院治疗NSTI，西班牙。
方法：进行了一项回顾性观察研究，包括2016年1月至2022年12月在我们中心接受手术治疗的所有NSTI患者，检查流行病学和临床数据。前瞻性计算所有患者的坏死性筋膜炎实验室风险指标（LRINEC）。
结果：22名患者（16名男性，6女人，平均年龄54.8）包括在内。从症状发作到急诊室就诊的中位时间为3.5天。所有患者均报告严重的治疗抗性疼痛；16例患者发热超过37.8ºC（72.7%）。皮肤病变发生在12例（54.5%），13例出现低血压和心动过速(59.1%)。治疗包括复苏支持，抗生素治疗,和彻底的清创术。手术的中位时间为8.25小时。20例患者的术中培养均为阳性：12例化脓性链球菌，四种金黄色葡萄球菌，一个大肠杆菌,和四种多微生物感染。住院死亡率为22.73%。
结论：我们检查了结果之间的相关性，截肢率和死亡率与LRINEC评分和手术时间。然而,我们发现与其他一些研究没有明显的关系。然而，采用多学科方法进行彻底清创和抗生素治疗，仍然是治疗的基石。我们的医院住了，结果和死亡率与我们的文献综述一致，确认高死亡率，尽管早期和适当的干预。
方法：进行了一项回顾性观察研究，包括2016年1月至2022年12月在我们中心接受手术治疗的所有NSTI患者，检查流行病学和临床数据。前瞻性计算所有患者的坏死性筋膜炎实验室风险指标（LRINEC）。
结果：22名患者（16名男性，6女人，平均年龄54.8）包括在内。从症状发作到急诊室就诊的中位时间为3.5天。所有患者均报告严重的治疗抗性疼痛；16例患者发热超过37.8ºC（72.7%）。皮肤病变发生在12例（54.5%），13例出现低血压和心动过速(59.1%)。治疗包括复苏支持，抗生素治疗,和彻底的清创术。手术的中位时间为8.25小时。20例患者的术中培养均为阳性：12例化脓性链球菌，四种金黄色葡萄球菌，一个大肠杆菌,和四种多微生物感染。住院死亡率为22.73%。
结论：我们检查了结果之间的相关性，截肢率和死亡率与LRINEC评分和手术时间。然而,我们发现与其他一些研究没有明显的关系。然而，采用多学科方法进行彻底清创和抗生素治疗，仍然是治疗的基石。我们的医院住了，结果和死亡率与我们的文献综述一致，确认高死亡率，尽管早期和适当的干预。
