Impact of prior antibiotic therapy on severe necrotizing soft-tissue infections in ICU patients: results from a French retrospective and observational study

Abstract

Necrotizing soft-tissue infection (NSTI) is a life-threatening pathology that often requires management in intensive care unit (ICU). Therapies consist of early diagnosis, adequate surgical source control, and antimicrobial therapy. Whereas guidelines underline the need for appropriate routine microbiological cultures before starting antimicrobial therapy in patients with suspected sepsis or septic shock, delaying adequate therapy also strongly increases mortality. The aim of the present study was to compare the characteristics and outcomes of patients hospitalized in ICU for NSTI according to their antimicrobial therapy exposure > 24 h before surgery (called the exposed group) or not (called the unexposed group) before surgical microbiological sampling. We retrospectively included 100 consecutive patients admitted for severe NSTI. The exposed group consisted of 23(23%) patients, while 77(77%) patients belonged to the unexposed group. The demographic and underlying disease conditions were similar between the two groups. Microbiological cultures of surgical samples were positive in 84 patients and negative in 16 patients, including 3/23 (13%) patients and 13/77 (17%) patients in the exposed and unexposed groups, respectively (p = 0.70). The distribution of microorganisms was comparable between the two groups. The main antimicrobial regimens for empiric therapy were also similar, and the proportions of adequacy were comparable (n = 60 (84.5%) in the unexposed group vs. n = 19 (86.4%) in the exposed group, p = 0.482). ICU and hospital lengths of stay and mortality rates were similar between the two groups. In conclusion, in a population of severe ICU NSTI patients, antibiotic exposure before sampling did not impact either culture sample positivity or microbiological findings.

Identifying patients with difficult-to-treat acute bacterial skin infections

“…In perineal gangrene, immunocompromised status and chronic wounds are known risk factors for multidrug resistance [38]. In NSTIs, prior antibiotic therapy before the onset of the disease did not seem to enhance the proportion of multidrug-resistant strains in the surgical samples [46]. In multivariate analysis, the only identified risk factor for the emergence of multidrug-resistant bacteria for reoperation of NSTIs is a prolonged delay before the initial source control [14].…”

Toxic Shock Syndrome: A Literature Review

“…In the case of NSTI-associated TSS, infection is frequently polymicrobial [61]. Broad spectrum beta-lactam therapy on Gram-positive cocci, Gram-negative bacilli, and anaerobic strains should be administered immediately without waiting for surgical exploration [60,62]. Multidrug-resistant bacteria must be targeted according to patient risk factors or local ecology [63].…”

Severe necrotizing soft-tissue infection-associated mortality: Have a look at the computed tomography!

“…We retrospectively collected data for 100 patients with severe NSTI hospitalized in our intensive care unit (ICU) between 2009 and 2019 and whose diagnoses were surgically confirmed. Methods of this cohort have been previously published [ 3 ]. Patients who were clinically suspected of having NSTI benefited from urgent surgical exploration.…”