Department of Critical Care Medicine, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China.
Department of Orthopedic Trauma, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China.
J Int Med Res. 2021 May;49(5):3000605211018442. doi: 10.1177/03000605211018442.
Necrotizing soft tissue infection (NSTI) is a rare but life-threatening bacterial infection. This study was performed to analyze the clinical characteristics of patients with NSTI admitted to the intensive care unit of a trauma and burn center in Beijing and to summarize the treatment experience.
This retrospective study involved patients with NSTI admitted to the intensive care unit from January 2010 to January 2020. The clinical manifestations, pathogens, laboratory test results, and prognosis were compared between survivors and nonsurvivors.
Thirty-two patients were enrolled (28 men, 4 women), including 25 (78.1%) survivors and 7 (21.9%) nonsurvivors. The patients' median age was 41.5 years (range, 30.0-52.5 years). Mortality was significantly higher in patients with a blood urea nitrogen concentration of ≥11.5 mg/dL, creatinine concentration of <3.4 mg/dL, prothrombin time of ≥15.9 s, and international normalized ratio of ≥1.3. and infections were associated with higher mortality.
More attention should be given to elderly patients and those with hyponatremia, coagulation disorder, and higher blood urea nitrogen or creatinine concentrations. The finding of large gram-positive rods or large numbers of gram-positive cocci in wound secretion smears is a helpful early warning sign of highly lethal NSTI.
坏死性软组织感染（NSTI）是一种罕见但危及生命的细菌性感染。本研究旨在分析北京某创伤与烧伤中心重症监护病房收治的 NSTI 患者的临床特征，并总结治疗经验。
本回顾性研究纳入 2010 年 1 月至 2020 年 1 月期间入住重症监护病房的 NSTI 患者。比较了幸存者和非幸存者之间的临床表现、病原体、实验室检查结果和预后。
共纳入 32 例患者（28 例男性，4 例女性），其中 25 例（78.1%）存活，7 例（21.9%）死亡。患者的中位年龄为 41.5 岁（范围：30.0-52.5 岁）。血尿素氮浓度≥11.5mg/dL、肌酐浓度<3.4mg/dL、凝血酶原时间≥15.9s 和国际标准化比值≥1.3 的患者死亡率显著更高。感染与更高的死亡率相关。
应更加关注老年患者以及伴有低钠血症、凝血障碍和更高血尿素氮或肌酐浓度的患者。伤口分泌物涂片发现大量革兰阳性杆菌或大量革兰阳性球菌是高度致命性 NSTI 的早期预警信号。
