Local variations in the epidemiology, microbiology, and outcome of necrotizing soft-tissue infections: a multicenter study

• Published in: The American journal of surgery Vol. 202; no. 2; pp. 139 - 145
• Main Authors: Kao, Lillian S, Lew, Debbie F, Arab, Samer N, Todd, S. Rob, Awad, Samir S, Carrick, Matthew M, Corneille, Michael G, Lally, Kevin P
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2011; Elsevier; Elsevier Limited
• Subjects: Adult; Age; Age Factors; Aged; Analysis of Variance; Biological and medical sciences; Chi-Square Distribution; Critical Care; Demographics; Demography; Epidemiology; Etiology; Fasciitis, Necrotizing - epidemiology; Fasciitis, Necrotizing - microbiology; Female; General aspects; Hospital Mortality; Hospitals; Hospitals, University - statistics & numerical data; Humans; Incidence; Kidneys; Laboratories; Logistic Models; Male; Medical Records; Medical sciences; Methicillin-resistant Staphylococcus aureus; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Microbiology; Middle Aged; Miscellaneous; Morbidity; Mortality; Necrosis; Necrotizing fasciitis; Necrotizing soft-tissue infections; Nonprofit hospitals; Patients; Populations; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression analysis; Renal failure; Retrospective Studies; Risk Factors; Sepsis; Severity of Illness Index; Soft Tissue Infections - epidemiology; Soft Tissue Infections - microbiology; Soft Tissue Infections - mortality; Soft Tissue Infections - pathology; Soft Tissue Infections - therapy; Staphylococcus infections; Statistical tests; Surgery; Texas - epidemiology; Tissues; Treatment Outcome; Variance analysis; Texas; United States > US; Necrotizing soft-tissue infections; Necrotizing fasciitis; Methicillin-resistant Staphylococcus aureus; Connective tissue disease; Skin disease; Prognosis; Microbiology; Methicillin-resistant; Multicenter study; Variations; Epidemiology; Infection; Medicine; Treatment; Surgery; Bacteriosis; Bacteria; Micrococcales; Evolution; Micrococcaceae; Soft tissue; Staphylococcal infection; Public health; Staphylococcus aureus
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2010.07.041

Abstract Background Necrotizing soft-tissue infections (NSTIs) are rare and highly lethal. Methods A retrospective chart review of patients with NSTIs treated at 6 academic hospitals in Texas between January 1, 2004 and December 31, 2007. Patient demographics, presentation, microbiology, treatment, and outcome were recorded. Analysis of variance, chi-square test, and logistic regression analysis were performed. Results Mortality rates varied between hospitals from 9% to 25% (n = 296). There was significant interhospital variation in patient characteristics, microbiology, and etiology of NSTIs. Despite hospital differences in treatment, primarily in critical care interventions, patient age and severity of disease (reflected by shock requiring vasopressors and renal failure postoperatively) were the main predictors of mortality. Conclusions Significant center differences occur in patient populations, etiology, and microbiology of NSTIs, even within a concentrated region. Management should be based on these characteristics given that adjunctive treatments are unproven and variations in outcome are likely because of patient disease at presentation.