RESUMO
RESUMO Objetivo: Descrever o prognóstico, os fatores de risco e a etiologia das infecções da pele e dos tecidos moles na unidade de terapia intensiva. Métodos: Estudo retrospectivo de uma coorte de 1.123 pacientes graves admitidos a uma unidade de terapia intensiva com o diagnóstico de infecção grave de pele ou tecidos moles. Resultados: Foram selecionados 30 pacientes, sendo 20 (66,7%) com fasceíte necrotizante, predominantemente da região perineal; 8 (26,7%) com abscesso cutâneo; e 2 (6,6%) com celulite. A maioria dos pacientes tinha fatores de risco, como imunossupressão e lesões cutâneas. O microrganismo isolado predominante foi Escherichia coli. Pacientes com fasceíte necrotizante na admissão à unidade de terapia intensiva apresentaram mortalidade significativamente maior (55%; p = 0,035), assim como aqueles com maior índice de severidade, choque séptico, parada cardiorrespiratória e leucocitose. Organismos resistentes à antibioticoterapia foram comuns, mesmo na ausência de fatores de risco. Quando presente, o fator de risco mais comum foi o uso prévio de antibiótico. Conclusão: Foram identificados fatores de risco e microrganismos diferentes dos classicamente descritos na literatura, além de elevada mortalidade da fasceíte necrotizante e presença de microrganismos multirresistentes na ausência de fatores de risco. Dada a aparente evolução etiológica das infecções da pele e tecidos moles, a identificação de novos fatores de risco e etiologia pode contribuir para uma terapêutica antimicrobiana mais adequada.
ABSTRACT Objective: To identify factors that may influence outcomes in patients with severe skin and soft tissue infections in the intensive care unit. Methods: A retrospective observational study was conducted in a cohort of 1,123 critically ill patients admitted to an intensive care unit with a primary or secondary diagnosis of severe skin and soft tissues infection between January 2006 and December 2014. Results: Thirty patients were included, 20 (66.7%) of whom were diagnosed with necrotizing fasciitis; in these patients, perineal area involvement was most commonly identified. Abscess was diagnosed in 8 (26.7%) patients, most commonly involving the cervical area. Risk factors such as immunosuppression and previous surgical trauma were commonly observed in this population. The most commonly isolated microorganism was Escherichia coli. Multidrug resistant microorganisms were commonly detected, even in the absence of traditional risk factors; among these patients, previous use of antibiotics was the most common risk factor for drug resistance. The rate of mortality was significantly higher in patients with necrotizing fasciitis (55%, p = 0.035) and associated with disease severity, presence of septic shock, cardiac arrest and leucocytosis. Conclusion: Different risk factors and etiologies of severe skin and soft tissue infections were identified. Necrotizing fasciitis and drug-resistant bacteria were significant predictors of mortality, even in the absence of traditional risk factors. Obtaining a better understanding of trends in the risk factors and microorganisms associated with severe skin infections may help in the determination of prompt treatment and antibiotic choices.