DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, and Ryder Trauma Center, Miami, Florida, USA.
Surg Infect (Larchmt). 2023 Jun;24(5):425-432. doi: 10.1089/sur.2023.037. Epub 2023 May 24.
Necrotizing soft tissue infections (NSTIs) are rapidly spreading, life-threatening infections that require emergent surgical intervention with immediate antibiotic initiation. However, there is no consensus regarding duration of antibiotic therapy after source control. We hypothesized that a short course of antibiotic therapy is as effective as a long course of antibiotic therapy after final debridement for NSTI. A systematic review of the literature was performed using PubMed, Embase, and Cochrane Library from inception to November 2022. Observational studies comparing short (≤7 days) versus long (>7 days) antibiotic duration for NSTI were included. Primary outcome was mortality and secondary outcomes included limb amputation and infection (CDI). Cumulative analysis was performed with Fisher exact test. Meta-analysis was performed using a fixed effects model and heterogeneity was assessed using Higgins . A total of 622 titles were screened and four observational studies evaluating 532 patients met inclusion criteria. Mean age was 52 years, 67% were male, 61% had Fournier gangrene. There was no difference in mortality when comparing short to long duration antibiotic agents on both cumulative analysis (5.6% vs. 4.0%; p = 0.51) and meta-analysis (relative risk, 0.9; 95% confidence interval, 0.8-1.0; 0; p = 0.19). There was no significant difference in rates of limb amputation (11% vs. 8.5%; p = 0.50) or CDI (20.8% vs. 13.3%; p = 0.14). Short duration antibiotic therapy may be as effective as longer duration antibiotic therapy for NSTI after source control. Further high-quality data such as randomized clinical trials are required to create evidence-based guidelines.
坏死性软组织感染（NSTI）是一种迅速扩散、危及生命的感染，需要紧急手术干预，并立即开始使用抗生素。然而，对于控制感染源后抗生素治疗的持续时间，目前尚无共识。我们假设，在 NSTI 最终清创后，短疗程抗生素治疗与长疗程抗生素治疗一样有效。
对 PubMed、Embase 和 Cochrane Library 从创建到 2022 年 11 月的文献进行系统综述。纳入比较 NSTI 短疗程（≤7 天）与长疗程（>7 天）抗生素治疗的观察性研究。主要结局是死亡率，次要结局包括肢体截肢和感染（CDI）。采用 Fisher 确切检验进行累积分析。采用固定效应模型进行荟萃分析，并采用 Higgins 评估异质性。
共筛选出 622 个标题，其中 4 项观察性研究评估了 532 例患者，符合纳入标准。平均年龄为 52 岁，67%为男性，61%患有 Fournier 坏疽。在累积分析和荟萃分析中，比较短疗程和长疗程抗生素时，死亡率均无差异（5.6%对 4.0%；p=0.51）和荟萃分析（相对风险，0.9；95%置信区间，0.8-1.0；I2=0；p=0.19）。肢体截肢率（11%对 8.5%；p=0.50）或 CDI 发生率（20.8%对 13.3%；p=0.14）也无显著差异。在控制感染源后，短疗程抗生素治疗可能与长疗程抗生素治疗一样有效。需要进一步的高质量数据，如随机临床试验，以制定基于证据的指南。
