Necrotizing soft tissue infections. Risk factors for mortality and strategies for management

Area of Science:

• Infectious Diseases
• Surgical Infections
• Critical Care Medicine

Background:

• Necrotizing soft tissue infections (NSTIs) are severe, life-threatening conditions.
• Previous studies on NSTI risk factors and optimal treatment have yielded conflicting results.
• Key debates include the impact of physiological derangements, infection type/extent, and hyperbaric oxygen therapy.

Purpose of the Study:

• To retrospectively analyze factors influencing outcomes in a large cohort of patients with NSTIs.
• To propose an evidence-based plan for optimal management of NSTIs.
• To identify predictors of mortality and organ failure in NSTI patients.

Main Methods:

• Retrospective chart review of 198 consecutive patients with NSTIs over 8 years.
• Logistic regression analysis to identify factors impacting patient outcomes.
• Evaluation of patient characteristics, clinical course, and treatment interventions.

Main Results:

• The overall mortality rate for NSTIs was 25.3%.
• Common infection sites included the perineum (36%) and diabetic foot (15.2%).
• Significant risk factors for mortality included advanced age, female gender, infection extent, delayed debridement, elevated creatinine/lactate, and organ dysfunction. Diabetes alone was not a risk factor unless combined with renal or vascular disease. Myonecrosis did not impact mortality.

Conclusions:

• NSTIs require prompt and aggressive treatment, including early and repeated extensive debridement and broad-spectrum antibiotics.
• Hyperbaric oxygen therapy may facilitate earlier wound closure.
• Identifying high-risk patients through specific markers aids in allocating intensive care resources effectively.