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Abstract：
BACKGROUND: Necrotizing fasciitis (NF) is a rare but potentially life-threatening soft tissue infection. The objective of this study was to assess the association between timely surgery within 6 h and hospital mortality in patients with limb NF, and to describe the trends in patients with NF, time to surgery and standardized mortality ratio (SMR) over 11 years.
METHODS: This was a multicenter, retrospective cohort study of all intensive care unit patients who had emergency surgery within 24 h of hospitalization for limb NF between April 1, 2008 and March 31, 2019 in Hong Kong. Timely surgery was defined as the first surgical treatment within 6 h of initial hospitalization. Appropriate antibiotics were achieved if the patient was given antibiotic(s) for all documented pathogens prior to or on day of culture results. The primary outcome was hospital mortality.
RESULTS: There were 495 patients (median age 62 years, 349 (70.5%) males) with limb NF treated by surgery within 24 h of hospitalization over the 11 years. Appropriate antibiotic(s) were used in 392 (79.2%) patients. There were 181 (36.5%) deaths. Timely surgery was not associated with hospital mortality (Relative Risk 0.89, 95% CI: 0.73 to 1.07) but admission year, advanced age, higher severity of illness, comorbidities, renal replacement therapy, vasopressor use, and type of surgery were significant predictors in the multivariable model. There was an upward trend in NF diagnosis (1.9 cases/year, 95% CI: 0.7 to 3.1; P < 0.01; R2 = 0.60) but there was no downward trend in median time to surgery (-0.2 h/year, 95% CI: -0.4 to 0.1; P = 0.16) or SMR (-0.02/year, 95% CI: -0.06 to 0.01; P = 0.22; R2 = 0.16).
CONCLUSIONS: Among patients operated within 24 h, very early surgery within 6-12 h was not associated with survival. Increasing limb NF cases were reported each year but mortality remained high despite a high rate of appropriate antibiotic use and timely surgical intervention.
METHODS: This was a multicenter, retrospective cohort study of all intensive care unit patients who had emergency surgery within 24 h of hospitalization for limb NF between April 1, 2008 and March 31, 2019 in Hong Kong. Timely surgery was defined as the first surgical treatment within 6 h of initial hospitalization. Appropriate antibiotics were achieved if the patient was given antibiotic(s) for all documented pathogens prior to or on day of culture results. The primary outcome was hospital mortality.
RESULTS: There were 495 patients (median age 62 years, 349 (70.5%) males) with limb NF treated by surgery within 24 h of hospitalization over the 11 years. Appropriate antibiotic(s) were used in 392 (79.2%) patients. There were 181 (36.5%) deaths. Timely surgery was not associated with hospital mortality (Relative Risk 0.89, 95% CI: 0.73 to 1.07) but admission year, advanced age, higher severity of illness, comorbidities, renal replacement therapy, vasopressor use, and type of surgery were significant predictors in the multivariable model. There was an upward trend in NF diagnosis (1.9 cases/year, 95% CI: 0.7 to 3.1; P < 0.01; R2 = 0.60) but there was no downward trend in median time to surgery (-0.2 h/year, 95% CI: -0.4 to 0.1; P = 0.16) or SMR (-0.02/year, 95% CI: -0.06 to 0.01; P = 0.22; R2 = 0.16).
CONCLUSIONS: Among patients operated within 24 h, very early surgery within 6-12 h was not associated with survival. Increasing limb NF cases were reported each year but mortality remained high despite a high rate of appropriate antibiotic use and timely surgical intervention.
摘要：
背景：坏死性筋膜炎（NF）是一种罕见但可能危及生命的软组织感染。这项研究的目的是评估在6小时内及时手术和住院死亡率之间的关系，并描述NF患者的趋势，手术时间和标准化死亡率（SMR）超过11年。
方法：这是一个多中心，2008年4月1日至2019年3月31日在香港对所有因肢体NF在住院后24小时内接受急诊手术的重症监护病房患者进行回顾性队列研究.及时手术被定义为首次住院6小时内的首次手术治疗。如果在培养结果之前或当天给予患者针对所有记录的病原体的抗生素,则获得适当的抗生素。主要结果是医院死亡率。
结果：有495名患者（中位年龄62岁，349（70.5％）男性）在11年内住院24小时内接受手术治疗的肢体NF。392例（79.2%）患者使用了适当的抗生素。有181人（36.5％）死亡。及时手术与住院死亡率无关(相对危险度0.89,95%CI:0.73-1.07),高龄,疾病的严重程度更高，合并症,肾脏替代疗法,血管加压药的使用,和手术类型是多变量模型中的重要预测因素。NF诊断呈上升趋势（1.9例/年，95％CI：0.7至3.1；P<0.01；R2=0.60），但中位手术时间没有下降趋势（-0.2h/年，95%CI：-0.4至0.1；P=0.16）或SMR（-0.02/年，95%CI：-0.06至0.01；P=0.22；R2=0.16）。
结论：在24小时内手术的患者中，在6-12小时内进行非常早期的手术与生存率无关.每年报告的肢体NF病例有所增加，但尽管适当使用抗生素和及时进行手术干预的比率很高，但死亡率仍然很高。
方法：这是一个多中心，2008年4月1日至2019年3月31日在香港对所有因肢体NF在住院后24小时内接受急诊手术的重症监护病房患者进行回顾性队列研究.及时手术被定义为首次住院6小时内的首次手术治疗。如果在培养结果之前或当天给予患者针对所有记录的病原体的抗生素,则获得适当的抗生素。主要结果是医院死亡率。
结果：有495名患者（中位年龄62岁，349（70.5％）男性）在11年内住院24小时内接受手术治疗的肢体NF。392例（79.2%）患者使用了适当的抗生素。有181人（36.5％）死亡。及时手术与住院死亡率无关(相对危险度0.89,95%CI:0.73-1.07),高龄,疾病的严重程度更高，合并症,肾脏替代疗法,血管加压药的使用,和手术类型是多变量模型中的重要预测因素。NF诊断呈上升趋势（1.9例/年，95％CI：0.7至3.1；P<0.01；R2=0.60），但中位手术时间没有下降趋势（-0.2h/年，95%CI：-0.4至0.1；P=0.16）或SMR（-0.02/年，95%CI：-0.06至0.01；P=0.22；R2=0.16）。
结论：在24小时内手术的患者中，在6-12小时内进行非常早期的手术与生存率无关.每年报告的肢体NF病例有所增加，但尽管适当使用抗生素和及时进行手术干预的比率很高，但死亡率仍然很高。
