Necrotising soft-tissue infections of the upper limb

Abstract

Necrotising soft-tissue infections (NSTIs) of the upper limb are uncommon, but potentially life-threatening. We used a national database to investigate the risk factors for amputation of the limb and death. We extracted data from the Japanese Diagnosis Procedure Combination database on 116 patients (79 men and 37 women) who had a NSTI of the upper extremity between 2007 and 2010. The overall in-hospital mortality was 15.5%. Univariate analysis of in-hospital mortality showed that the significant variables were age (p = 0.015), liver dysfunction (p = 0.005), renal dysfunction (P < 0.001), altered consciousness (p = 0.049), and sepsis (p = 0.021). Logistic regression analysis showed that the factors associated with death in hospital were age over 70 years (Odds Ratio (OR) 6.6; 95% confidence interval (CI) 1.5 to 28.2; p = 0.011) and renal dysfunction (OR 15.4; 95% CI 3.8 to 62.8; p < 0.001). Univariate analysis of limb amputation showed that the significant variables were diabetes (p = 0.017) mellitus and sepsis (p = 0.001). Multivariable logistic regression analysis showed that the factors related to limb amputation were sepsis (OR 1.8; 95% CI 1.5 to 24.0; p = 0.013) and diabetes mellitus (OR 1.6; 95% CI 1.1 to 21.1; p = 0.038). For NSTIs of the upper extremity, advanced age and renal dysfunction are both associated with a higher rate of in-hospital mortality. Sepsis and diabetes mellitus are both associated with a higher rate of amputation.

Factors Associated with Mortality and Amputation Caused by Necrotizing Soft Tissue Infections of the Upper Extremity: A Retrospective Cohort Study

“…The mortality rate probably decreased due to improvement in awareness and treatment, both in surgical care and in critical care support [9]. The cumulative mortality rate described for upper extremity NSTIs is 18.3% (90 patients died out of 493 included patients in 8 studies), with rates as low as 9% and as high as 36% [6,[18][19][20][21][22][23][24]. The low mortality rate in this study might be caused by the relatively large group of intravenous drug user and type II NSTIs.…”

The global diabetes epidemic: what does it mean for infectious diseases in tropical countries?

“…[12][13][14] Infections are not only more common in people with diabetes but can also be more severe than in those without diabetes. For instance, observational studies have shown diabetes to be associated with both increased rate of hospital admission and increased time spent in hospital because of infections; increased rates of admission to intensive care units; increased mortality for pneumonia, bloodstream infections, and influenza; [13][14][15][16] increased rates of amputation and death for necrotising limb infections; 17 and greatly increased rates of endogenous endophthalmitis among patients with fungaemia or bacteraemia. 18 Diabetes might also affect antibiotic treatment; it has been associated with increased antimicrobial drug resistance-eg, among Enterobacteriaceae 19-21 -whereas impaired kidney function and liver steatosis associated with diabetes increase the risk of antimicrobial drug toxicity.…”

Diabetes and necrotizing soft tissue infections—A prospective observational cohort study: Statistical analysis plan

“…Necrotizing soft tissue infections (NSTIs) are uncommon, severe, and potentially lethal conditions. 1,2 Surviving often comes at the prize of life-lasting morbidity. 3 NSTI typically presents with pain, swelling, and skin discoloration 4 .…”