Trends in 393 necrotizing acute soft tissue infection patients 2000-2008.
Burns
; 38(2): 252-60, 2012 Mar.
Article
em En
| MEDLINE
| ID: mdl-22030440
ABSTRACT
OBJECTIVE:
To determine the outcomes effect of changing trends in patients with necrotizing acute soft tissue infections (NASTI) 2000-2008.METHODS:
A single institution retrospective chart review of all patients treated for NASTI.RESULTS:
There were 393 patients with mean age 50 years, diabetes 53%, % body surface area excised 3.5. Wounds were located on extremity 57%, perineum 40%, trunk 26%. Wound cultures % polymicrobial=62, Staphylococci=48, Streptococci=31. Patients developing complications % Pulmonary=23, renal insufficiency/failure=27. During the study period, overall mortality rate remained unchanged 30/393=7.6% (5.5% for patients first admitted by burn/trauma/acute care surgery vs. 29% for all other services, p=0.003). Significant annual increases were found in number of patients, p=0.03, male sex, p=0.000, transfer from outside hospital, p<0.001, BMI p=0.003, ventilator requirement >24h, p=0.0005, APACHE II p=0.002, and number of patients developing any complication, p=0.04. Statistically significant decreases annually were found in days of antibiotic use, p=0.008, number of operations required for excision, p=0.02, development of non-wound infections, p=0.002, and length of stay in days (LOS), p=0.03.CONCLUSIONS:
This is the largest cohort of NASTI patients from a single institution to date, demonstrating significantly shorter LOS and decreased non-wound infection rates in the face of increasing BMI and APACHE II scores. The increasing number of patients and BMI suggests a causal relationship between NASTI and obesity. Initial care by surgeons experienced in caring for these patients provides mortality rates well below the national average.
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Base de dados:
MEDLINE
Assunto principal:
Infecção dos Ferimentos
/
Queimaduras
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Infecções dos Tecidos Moles
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Fasciite Necrosante
Idioma:
En
Ano de publicação:
2012
Tipo de documento:
Article