Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA.
Am J Surg. 2011 Aug;202(2):139-45. doi: 10.1016/j.amjsurg.2010.07.041. Epub 2011 May 4.
Necrotizing soft-tissue infections (NSTIs) are rare and highly lethal.
A retrospective chart review of patients with NSTIs treated at 6 academic hospitals in Texas between January 1, 2004 and December 31, 2007. Patient demographics, presentation, microbiology, treatment, and outcome were recorded. Analysis of variance, chi-square test, and logistic regression analysis were performed.
Mortality rates varied between hospitals from 9% to 25% (n = 296). There was significant interhospital variation in patient characteristics, microbiology, and etiology of NSTIs. Despite hospital differences in treatment, primarily in critical care interventions, patient age and severity of disease (reflected by shock requiring vasopressors and renal failure postoperatively) were the main predictors of mortality.
Significant center differences occur in patient populations, etiology, and microbiology of NSTIs, even within a concentrated region. Management should be based on these characteristics given that adjunctive treatments are unproven and variations in outcome are likely because of patient disease at presentation.
坏死性软组织感染（NSTIs）罕见且具有高度致命性。
对 2004 年 1 月 1 日至 2007 年 12 月 31 日期间在德克萨斯州 6 所学术医院治疗的 NSTI 患者进行回顾性图表审查。记录患者的人口统计学、表现、微生物学、治疗和结局。进行方差分析、卡方检验和逻辑回归分析。
死亡率在各医院之间从 9%到 25%不等（n=296）。患者特征、微生物学和 NSTI 的病因在各医院之间存在显著差异。尽管各医院在治疗方面存在差异，主要表现在重症监护干预方面，但患者年龄和疾病严重程度（表现为需要血管加压药的休克和术后肾功能衰竭）是死亡的主要预测因素。
即使在集中的地区，NSTIs 在患者人群、病因和微生物学方面也存在显著的中心差异。鉴于辅助治疗尚未得到证实，并且由于患者就诊时的疾病不同，结果可能存在差异，因此应根据这些特征进行治疗。
