Predictors of Monomicrobial Necrotizing Soft Tissue Infections

Willis, Rhett N.; Guidry, Christopher A.; Horn, Christopher B.; Gilsdorf, Daniel; Davies, Stephen; Dietch, Zachary C.; Sawyer, Robert G.

doi:10.1089/sur.2014.189

Cited by 11 publications

(4 citation statements)

References 33 publications

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“…They can be further divided by tissue layer, such as necrotizing fasciitis when involving fascia or myositis when involving muscle, or by anatomic location, such as Fournier gangrene when present in the genitalia and perineum [1][2][3][4]. These infections are polymicrobial up to 80% of the time, with a predominance of group A Streptococcus (GAS), Staphylococcus aureus, Enterococcus, and multiple anaerobic bacterial species [2,[5][6][7].…”

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confidence: 99%

Obesity Is Not an Independent Predictor of Necrotizing Soft Tissue Infection Outcomes

Zhao-Fleming

Almekdash

Cook

et al. 2021

Surgical Infections

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Background: Necrotizing soft tissue infections (NSTIs) are a group of rapidly progressive infections of the skin and its underlying tissue. These infections result in substantial morbidity and mortality. The focus of this study was to determine if obesity is associated with a worsened clinical outcome or prolonged hospital course for patients with NSTIs. Patients and Methods: We conducted a retrospective chart review of patients with NSTI presenting to a single tertiary hospital. Fat content, measured with body mass index (BMI) and abdominal fat thicknesses, including subcutaneous and visceral fat, were compared against primary and secondary outcomes of NSTIs. Results: We found that women had a higher mortality rate compared with men (27% vs. 15% mortality). Women also had an increased subcutaneous abdominal fat thickness (55.7 vs. 36.9 mm, p = 0.028). However, no measurements of fat, BMI, subcutaneous fat, or visceral fat differed between survivors and mortalities of NSTIs. In fact, with the exception of a higher BMI in those who developed acute kidney injury (AKI, p = 0.034), we found no correlation between increases in fat measurement and secondary outcome, including propensity to develop sepsis during hospitalization, length of hospital stay, length of intensive care stay, or antibiotic usage. Multivariable logistic regression analysis was conducted, and we found no statistically significant differences in primary or secondary outcomes. Conclusion: Women appear to have a higher mortality in NSTI, although the reasons for this are unclear. Obesity, as measured by BMI, subcutaneous, and visceral fat thicknesses, does not appear to be an independent risk factor.

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confidence: 99%

Obesity Is Not an Independent Predictor of Necrotizing Soft Tissue Infection Outcomes

Zhao-Fleming

Almekdash

Cook

et al. 2021

Surgical Infections

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“…Thus, prior investigations in NSTI have revealed a higher occurrence of monomicrobial infections, including GAS, in the upper extremities, while polymicrobial infections were more common in the truncal region (28). This study found a negative association between other surgeries performed last four weeks prior to the NSTI and GAS aetiology.…”

Section: Discussionmentioning

confidence: 97%

A validated model for early prediction of group A streptococcal aetiology and clinical endpoints in necrotising soft tissue infections

Katz,

Suijker,

Skrede

et al. 2024

Preprint

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ObjectivesTo develop and externally validate machine learning models for predicting microbial aetiology and clinical endpoints, encompassing surgery, patient management, and organ support in Necrotising Soft Tissue Infections (NSTI).MethodsPredictive models for the presence of Group A Streptococcus (GAS) and for five clinical endpoints (risk of amputation, size of skin defect, maximum skin defect size, length of ICU stay, and need for renal replacement therapy) were built and trained using data from the prospective, international INFECT cohort (409 patients, 2013-2017), implementing unsupervised variable selection, and comparing several algorithms. SHapley Additive exPlanations (SHAP) analysis was used to interpret the model. GAS predictive models were externally validated using data from a Dutch retrospective multicenter cohort from the same calendar period (216 patients).ResultsEight variables available pre-surgery (age, diabetes, affected anatomical locations, prior surgical interventions, and creatinine and haemoglobin levels) sufficed for prediction of GAS aetiology with high discriminatory power in both the development (ROC-AUC: 0.828; 95%CI 0.763, 0.883) and validation cohort (ROC-AUC: 0.758; 95%CI 0.696, 0.821). The prediction of clinical endpoints related to surgical, patient management, and organs support aspects was unsuccessful.ConclusionAn externally validated prediction model for GAS aetiology before organ support aspects was unsuccessful, having implications for targeted treatment decisions of NSTI.

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“…With more than 50% of patients presenting with septic shock, urgent and bactericidal intravenous antibiotics are recommended [11,12]. NSTIs are often polymicrobial, and although some admission characteristics have been correlated with monomicrobial forms [18,121,122], even the site of infection is insufficient to guide empiric antibiotic treatment [4,19,123,124]. This should cover both gram positive, gram-negative, and anaerobic bacteria, usually with a broad-spectrum β-lactam (e.g., piperacillin-tazobactam).…”

Section: Suggested Empiric Treatment For Suspected Nsti Based On Basic Microbiologymentioning

confidence: 99%

Antibiotics in Necrotizing Soft Tissue Infections

et al. 2021

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Necrotizing soft tissue infections (NSTIs) are rare life-threatening bacterial infections characterized by an extensive necrosis of skin and subcutaneous tissues. Initial urgent management of NSTIs relies on broad-spectrum antibiotic therapy, rapid surgical debridement of all infected tissues and, when present, treatment of associated organ failures in the intensive care unit. Antibiotic therapy for NSTI patients faces several challenges and should (1) carry broad-spectrum activity against gram-positive and gram-negative pathogens because of frequent polymicrobial infections, considering extended coverage for multidrug resistance in selected cases. In practice, a broad-spectrum beta-lactam antibiotic (e.g., piperacillin-tazobactam) is the mainstay of empirical therapy; (2) decrease toxin production, typically using a clindamycin combination, mainly in proven or suspected group A streptococcus infections; and (3) achieve the best possible tissue diffusion with regards to impaired regional perfusion, tissue necrosis, and pharmacokinetic and pharmacodynamic alterations. The best duration of antibiotic treatment has not been well established and is generally comprised between 7 and 15 days. This article reviews the currently available knowledge regarding antibiotic use in NSTIs.

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Predictors of Monomicrobial Necrotizing Soft Tissue Infections

Cited by 11 publications

References 33 publications

Obesity Is Not an Independent Predictor of Necrotizing Soft Tissue Infection Outcomes

Obesity Is Not an Independent Predictor of Necrotizing Soft Tissue Infection Outcomes

A validated model for early prediction of group A streptococcal aetiology and clinical endpoints in necrotising soft tissue infections

Antibiotics in Necrotizing Soft Tissue Infections

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