Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Department of Medicine, Haukeland University Hospital, Bergen, Norway.
Intensive Care Med. 2019 Sep;45(9):1241-1251. doi: 10.1007/s00134-019-05730-x. Epub 2019 Aug 22.
Necrotising soft-tissue infections (NSTI) are characterised by necrosis, fast progression, and high rates of morbidity and mortality, but our knowledge is primarily derived from small prospective studies and retrospective studies.
We performed an international, multicentre, prospective cohort study of adults with NSTI describing patient's characteristics and associations between baseline variables and microbiological findings, amputation, and 90-day mortality.
We included 409 patients with NSTI; 402 were admitted to the ICU. Cardiovascular disease [169 patients (41%)] and diabetes [98 (24%)] were the most common comorbidities; 122 patients (30%) had no comorbidity. Before surgery, bruising of the skin [210 patients (51%)] and pain requiring opioids [172 (42%)] were common. The sites most commonly affected were the abdomen/ano-genital area [140 patients (34%)] and lower extremities [126 (31%)]. Monomicrobial infection was seen in 179 patients (44%). NSTI of the upper or lower extremities was associated with monomicrobial group A streptococcus (GAS) infection, and NSTI located to the abdomen/ano-genital area was associated with polymicrobial infection. Septic shock [202 patients (50%)] and acute kidney injury [82 (20%)] were common. Amputation occurred in 22% of patients with NSTI of an extremity and was associated with higher lactate level. All-cause 90-day mortality was 18% (95% CI 14-22); age and higher lactate levels were associated with increased mortality and GAS aetiology with decreased mortality.
Patients with NSTI were heterogeneous regarding co-morbidities, initial symptoms, infectious localisation, and microbiological findings. Higher age and lactate levels were associated with increased mortality, and GAS infection with decreased mortality.
坏死性软组织感染（NSTI）以坏死、快速进展以及高发病率和死亡率为特征，但我们的知识主要来自小型前瞻性研究和回顾性研究。
我们对成人 NSTI 患者进行了一项国际性、多中心、前瞻性队列研究，描述了患者的特征以及基线变量与微生物学发现、截肢和 90 天死亡率之间的关系。
我们纳入了 409 例 NSTI 患者；其中 402 例患者入住 ICU。心血管疾病[169 例（41%）]和糖尿病[98 例（24%）]是最常见的合并症；122 例（30%）无合并症。手术前，皮肤瘀斑[210 例（51%）]和需要阿片类药物的疼痛[172 例（42%）]很常见。最常受影响的部位是腹部/肛门生殖器区域[140 例（34%）]和下肢[126 例（31%）]。179 例（44%）患者为单微生物感染。上肢或下肢的 NSTI 与单微生物 A 组链球菌（GAS）感染相关，而腹部/肛门生殖器区域的 NSTI 与多微生物感染相关。败血症性休克[202 例（50%）]和急性肾损伤[82 例（20%）]很常见。NSTI 发生于四肢的患者中有 22%进行了截肢，且与较高的血乳酸水平相关。所有原因的 90 天死亡率为 18%（95%CI 14-22）；年龄和较高的血乳酸水平与死亡率增加相关，而 GAS 病因与死亡率降低相关。
NSTI 患者在合并症、初始症状、感染定位和微生物学发现方面存在异质性。较高的年龄和血乳酸水平与死亡率增加相关，而 GAS 感染与死亡率降低相关。
