Predictors of Mortality in Patients With Necrotizing Fasciitis: A Literature Review and Multivariate Analysis.

Background: Necrotizing fasciitis (NF) is a life-threatening infectious disease that can result in significant morbidity and mortality. Previously identified factors have not been verified in a large population. The objective of this study is to further examine the relationship of patient factors in NF mortality. Methods: This study is a retrospective review on patients ≥18 years old diagnosed with NF at the provincial referral centres from 2004 to 2016. The following data were examined: demographics, comorbidities, laboratory values, length of stay, and inhospital mortality. Results: Three hundred forty patients satisfied the inclusion criteria: 297 survived and were discharged, 43 died in hospital. In multivariate analysis, a prognostic model for NF mortality identified age >60 years, elevated creatinine, abnormal blood platelets, and group A ß-hemolytic Streptococcus (GABS) infection. Conclusions: Multiple factors were associated with mortality in NF. The strongest univariate association with mortality was age >60 years. In addition, a history of hypertension and/or dyslipidemia, renal disease, and the presence of GABS contributed to a predictive model for inhospital NF mortality.

Contexte: La fasciite nécrosante (FN) est une maladie infectieuse mettant la vie en danger et pouvant déboucher sur une morbidité et mortalité significatives. Les facteurs précédemment identifiés n'ont pas été vérifiés dans une large population. Cette étude avait pour objectif d'examiner plus en détail le rapport entre les facteurs liés au patient dans la mortalité de la FN. Méthodes: Il s'agit d'une étude rétrospective sur des patients âgés de ≥ 18 ans ayant eu un diagnostic de FN dans des centres de référence provinciaux de 2004 à 2016. Les données suivantes ont été examinées: Données démographiques, comorbidités, résultats des tests de laboratoire, durée du séjour à l'hôpital et mortalité à l'hôpital. Résultats: 340 patients ont satisfait les critères d'inclusion: 297 patients ont survécu et ont reçu leur congé; 43 patients sont décédés à l'hôpital. Un modèle pronostique pour la mortalité dans la FN a identifié dans une analyse multifactorielle un âge > 60 ans, une élévation de la créatinine, des plaquettes sanguines anormales et une infection par des streptocoques ß hémolytiques du groupe A (SGA). Conclusions: De nombreux facteurs sont associés à la mortalité dans la FN. L'association unifactorielle la plus forte avec la mortalité était un âge > 60 ans. De plus, des antécédents d'hypertension et/ou de dyslipidémie, une maladie rénale, et la présence de SGA ont contribué au modèle prédictif de la mortalité hospitalière liée à la FN.

Narrative discourse of burn injury and recovery on peer support websites: A qualitative analysis.

Although advances have been made in burn care and recovery, less is known about the experience of living with severe burn injury. Like other patient groups, burn survivors are now turning to social media and shared web-based peer support resources during recovery and continuing long after discharge. Ongoing peer support is often part of the reclamation process after-burn injury. Peer support and event sharing helps foster hope, motivation and reassurance. OBJECTIVES: To: 1) Examine and further understand the narrative discourse of burn survivorship in peer support social media content, 2) establish commonalities in the sharing community and key themes related to recovery and adaptation. METHODS: This qualitative enquiry began with a comprehensive overview of burn narratives on survivor peer generated websites. We conducted a purposeful sampling of 21 biographies posted on burn survivor peer and patient support websites. Participants with greater than 30% burn injury were included that provided narrative and discourse regarding burn recovery and survivorship. Underlying story arcs, meaning behind sentences and shared language of the experience were investigated using thematic analysis. RESULTS: Four themes were identified: retelling of the traumatic event; social support; body image, the new normal; and rebirth and transformation. Accounts reflected the traumatic nature of the event with slowed downtime, attention to details and heightened recall. The value of peer and family support was a common theme. There was attention to the challenges related to changed body image and regaining confidence in body appearance. Most stories also documented transitioning and rebirth and other more positive aspects of trauma recovery. CONCLUSIONS: Accounting the burn experience and recovery is part of the reclamation process. Biographies document the trauma recovery process. Storying the event is an integral component of burn survivor community content. These online communities have become a mainstream resource and part of the reclamation process.

Rate of contamination of hospital privacy curtains in a burns/plastic ward: A longitudinal study.

BACKGROUND: Since hospital patient privacy curtains can harbor bacteria, are high-touch surfaces, and are cleaned infrequently, they may be involved in pathogen transmission. The aim of this longitudinal prospective study was to understand curtain contamination to inform curtain hygiene protocols, thereby minimizing the role of curtains in pathogen transmission. METHODS: Over 21 days, cultures of 10 freshly laundered curtains (8 test curtains surrounding patient beds and 2 controls in an unoccupied staff room) were taken in the Regional Burns/Plastics Unit. Contact plates were used to sample the curtains near the edge hem where they are most frequently touched. Microbial contamination and the presence of methicillin-resistant Staphylococcus aureus (MRSA) were determined. RESULTS: By day 3, test curtains showed increased microbial contamination (mean colony-forming units [CFU]/cm2 = 1.17) compared to control curtains (mean CFU/cm2 = 0.19). Test curtains became increasingly contaminated over time, with mean CFU/cm2 for days 17 and 21 of 1.86 and 5.11, respectively. By day 10, 1/8 test curtains tested positive for MRSA, and 5/8 were positive by day 14. CONCLUSIONS: Patient privacy curtains became progressively contaminated with bacteria, including MRSA. Between days 10 and 14 after being hung, curtains showed increased MRSA positivity. This may represent an opportune time to intervene, either by cleaning or replacing the curtains.