Moore-Lotridge Stephanie N, Johnson Samuel R, Jamal Naadir H, Chandrashekar Anoop S, Hou Brian Q, Ramalingam Wendy, Schoenecker Jonathan G
Departments of Orthopaedic Surgery.
Vanderbilt Center for Bone Biology.
J Pediatr Orthop. 2025 Jul 15. doi: 10.1097/BPO.0000000000003046.
Necrotizing soft tissue infections (NSTI) are rare but potentially life-threatening infections that can occur in both pediatric and adult patients. To date, few studies have examined NSTI in pediatric populations. Thus, the majority of guidelines for diagnosis and managing NSTI are based on adult data. The goal of this study was to utilize a large retrospective database to compare and contrast adult and pediatric cases of NSTI from a single center.
A retrospective review from a single tertiary center identified 446 patients with confirmed NSTI, 27 children (below 18 years of age) and 419 adults. Records were verified for the presence of disease based on retrospective review of a deidentified EMR (notes, reports, etc.). Demographics including age, sex, infection origin, comorbidities, patient presenting symptoms, and mortality rate were compared.
Between children and adults with confirmed NF, similar rates of sex and ethnic distribution were observed. Upon admission, pain, erythema, and swelling were present at similar rates between cohorts. The origin and mechanism of infection were markedly different between cohorts with children experiencing extremity infections at double the rate of adults (76.9% vs. 34.1%). In patients with available culture data, tissue culture results were significantly different between cohorts with children developing culture-negative NSTI at more than 5× the rate of adults (20.0% vs. 4.6%). Finally, children had significantly lower mortality rates than adults (3.7% vs. 20.3%). Given this variability, a focused analysis of extremity cases of NSTI was conducted. Similar rates of ICU admission and peak C-reactive protein levels were identified, but adults experienced a significantly greater rate of amputation (5.5% vs. 27.8%) and organ dysfunction (38.9% vs. 76.7%) compared with children. As such, adults still maintained a significantly higher mortality rate compared with children (5.5% vs. 27.8).
Cases of pediatric NSTI differ from those of adults, including variable patient outcomes. These unique features raise the question of whether equally aggressive operative management of NSTI, traditionally applied in adults, is necessary for pediatric cases. As such, future studies differentiating NSTI from other severe forms of infection, efforts to optimize treatment, and continued education for adult community providers remain warranted to support physicians treating pediatric cases of NSTI.
Level III.
坏死性软组织感染（NSTI）虽罕见，但可能危及生命，可发生于儿童和成人患者。迄今为止，很少有研究对儿科人群中的NSTI进行研究。因此，大多数NSTI诊断和管理指南是基于成人数据制定的。本研究的目的是利用一个大型回顾性数据库，比较和对比来自单一中心的成人和儿科NSTI病例。
对一家单一的三级中心进行回顾性研究，确定了446例确诊为NSTI的患者，其中27例为儿童（18岁以下），419例为成人。通过对去识别化的电子病历（笔记、报告等）进行回顾性审查，核实疾病的存在情况。比较了人口统计学特征，包括年龄、性别、感染源、合并症、患者出现的症状和死亡率。
在确诊为NF的儿童和成人中，观察到相似的性别和种族分布率。入院时，各队列中疼痛、红斑和肿胀的发生率相似。各队列之间感染的起源和机制明显不同，儿童发生肢体感染的比例是成人的两倍（76.9%对34.1%）。在有可用培养数据的患者中，各队列之间的组织培养结果有显著差异，儿童发生培养阴性NSTI的比例是成人的5倍多（20.0%对4.6%）。最后，儿童的死亡率明显低于成人（3.7%对20.3%）。鉴于这种差异，对NSTI的肢体病例进行了重点分析。确定了相似的重症监护病房入院率和C反应蛋白峰值水平，但与儿童相比，成人的截肢率（5.5%对27.8%）和器官功能障碍率（38.9%对76.7%）明显更高。因此，与儿童相比，成人的死亡率仍然明显更高（5.5%对27.8%）。
儿科NSTI病例与成人病例不同，包括患者的不同预后。这些独特特征引发了一个问题，即传统上应用于成人的同样积极的NSTI手术管理对于儿科病例是否必要。因此，未来仍有必要开展将NSTI与其他严重感染形式区分开来的研究、优化治疗的努力以及对成人社区医疗服务提供者的持续教育，以支持治疗儿科NSTI病例的医生。
三级。
