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Necrotizing Soft Tissue Infections in Intensive Care
Alexandru Ogica1, Christoph Burdelski1, Holger Rohde2
1Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Journal of Intensive Care Medicine
|April 26, 2021
Summary
Necrotizing soft tissue infections (NSTIs) are severe, often fatal conditions. High serum lactate levels upon intensive care unit (ICU) admission can predict mortality in patients with NSTIs.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Surgical Infections
Background:
- Necrotizing soft tissue infections (NSTIs) are characterized by rapid tissue destruction and systemic toxicity, frequently leading to sepsis or septic shock.
- These infections pose a significant threat, necessitating intensive care unit (ICU) admission for management.
Purpose of the Study:
- To analyze the clinical characteristics, microbiology, laboratory data, treatments, and outcomes of patients with NSTIs admitted to the ICU.
- To evaluate the prognostic value of specific clinical and laboratory parameters, including serum lactate and SOFA score, in predicting ICU mortality.
Main Methods:
- A monocentric observational study was conducted on patients admitted to a university hospital's ICU between January 2009 and December 2017.
- Retrospective analysis included demographic data, comorbidities, clinical presentation, microbiological findings, laboratory results, organ dysfunction, therapies, and patient outcomes.
Main Results:
- The study included 59 patients, with 70% males, mean age 55 ± 18. Type II NSTI was observed in 61% of patients, with *Streptococcus pyogenes* being the most common pathogen (48%).
- Septic shock occurred in 70% of patients, with circulatory and renal dysfunctions being most prevalent. Mean ICU mortality was 25%.
- Serum lactate levels (mean 4.22 ± 5.42 mmol/L) and SOFA scores (median 7) were significantly correlated with ICU mortality (P < 0.001 and P < 0.007, respectively). A lactate cut-off of 6.55 mmol/L predicted mortality with 97% specificity.
Conclusions:
- NSTIs are associated with a high risk of septic shock, multiple organ dysfunction syndrome, and significant mortality.
- Serum lactate levels at ICU admission serve as a valuable and easily measurable prognostic indicator for NSTI patients.
- This parameter can aid in clinical decision-making regarding prognosis and the continuation of care for patients with NSTIs.
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