NSTI Organisms and Regions: A Multicenter Study From the American Association for the Surgery of Trauma

Alvancin Louis, Stephanie Savage, Garth H Utter, Shi Wen Li, Marie Crandall

Research output: Contribution to journalArticle

Abstract

Background: Conflicting data on the microbiology and epidemiology of necrotizing soft tissue infections (NSTIs) appear to stem from the heterogeneity in microbiology observed in regions across the United States. Our goal was to determine current differences in organism prevalence and outcomes for NSTI and non-necrotizing severe soft tissue infections across the United States. We hypothesized that there were geographical differences in organism prevalence that would lead to differences in outcomes. Materials and Methods: This study was a retrospective multi-institutional trial from centers across the United States and Canada. Demographic, clinical, and outcomes data were collected. Bivariate and multivariable analyses were performed to determine the effects of region and microbiology on outcomes. Results: A total of 622 patients were included in this study. Polymicrobial infections (45%) were the most prevalent infections in all regions. On bivariate analysis, Clostridium and polymicrobial infections had higher mean Laboratory Risk Indicator for Necrotizing Fasciitis scores and American Association for the Surgery of Trauma grades (P < 0.001 for both) than other organisms. Patients in the South were more likely to be uninsured and had worse unadjusted outcomes. In a risk-adjusted model, increasing American Association for the Surgery of Trauma grade was predictive of mortality (OR, 2.3; 95% CI, 1.6–3.1; P < 0.001), as was age ≥ 55 y (OR 2.7, 95% CI 1.3–5.3, P = 0.006), but region and organism type were not associated with mortality. Conclusions: We found important regional differences with respect to organism type and demographics. However, on risk-adjusted models, neither region nor organism type predicted mortality.

Original languageEnglish (US)
Pages (from-to)108-113
Number of pages6
JournalJournal of Surgical Research
Volume243
DOIs
StatePublished - Nov 1 2019

Fingerprint

Soft Tissue Infections
Microbiology
Multicenter Studies
Coinfection
Mortality
Wounds and Injuries
Demography
Clostridium Infections
Necrotizing Fasciitis
Canada
Epidemiology
Infection

Keywords

  • AAST emergency general surgery grading scale
  • LRINEC score
  • Necrotizing soft tissue infections
  • Skin and soft tissue infections

ASJC Scopus subject areas

  • Surgery

Cite this

NSTI Organisms and Regions : A Multicenter Study From the American Association for the Surgery of Trauma. / Louis, Alvancin; Savage, Stephanie; Utter, Garth H; Li, Shi Wen; Crandall, Marie.

In: Journal of Surgical Research, Vol. 243, 01.11.2019, p. 108-113.

Research output: Contribution to journalArticle

Louis, Alvancin ; Savage, Stephanie ; Utter, Garth H ; Li, Shi Wen ; Crandall, Marie. / NSTI Organisms and Regions : A Multicenter Study From the American Association for the Surgery of Trauma. In: Journal of Surgical Research. 2019 ; Vol. 243. pp. 108-113.
@article{a2a7e1c1c8e24922a634469285cded9f,
title = "NSTI Organisms and Regions: A Multicenter Study From the American Association for the Surgery of Trauma",
abstract = "Background: Conflicting data on the microbiology and epidemiology of necrotizing soft tissue infections (NSTIs) appear to stem from the heterogeneity in microbiology observed in regions across the United States. Our goal was to determine current differences in organism prevalence and outcomes for NSTI and non-necrotizing severe soft tissue infections across the United States. We hypothesized that there were geographical differences in organism prevalence that would lead to differences in outcomes. Materials and Methods: This study was a retrospective multi-institutional trial from centers across the United States and Canada. Demographic, clinical, and outcomes data were collected. Bivariate and multivariable analyses were performed to determine the effects of region and microbiology on outcomes. Results: A total of 622 patients were included in this study. Polymicrobial infections (45{\%}) were the most prevalent infections in all regions. On bivariate analysis, Clostridium and polymicrobial infections had higher mean Laboratory Risk Indicator for Necrotizing Fasciitis scores and American Association for the Surgery of Trauma grades (P < 0.001 for both) than other organisms. Patients in the South were more likely to be uninsured and had worse unadjusted outcomes. In a risk-adjusted model, increasing American Association for the Surgery of Trauma grade was predictive of mortality (OR, 2.3; 95{\%} CI, 1.6–3.1; P < 0.001), as was age ≥ 55 y (OR 2.7, 95{\%} CI 1.3–5.3, P = 0.006), but region and organism type were not associated with mortality. Conclusions: We found important regional differences with respect to organism type and demographics. However, on risk-adjusted models, neither region nor organism type predicted mortality.",
keywords = "AAST emergency general surgery grading scale, LRINEC score, Necrotizing soft tissue infections, Skin and soft tissue infections",
author = "Alvancin Louis and Stephanie Savage and Utter, {Garth H} and Li, {Shi Wen} and Marie Crandall",
year = "2019",
month = "11",
day = "1",
doi = "10.1016/j.jss.2019.05.006",
language = "English (US)",
volume = "243",
pages = "108--113",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - NSTI Organisms and Regions

T2 - A Multicenter Study From the American Association for the Surgery of Trauma

AU - Louis, Alvancin

AU - Savage, Stephanie

AU - Utter, Garth H

AU - Li, Shi Wen

AU - Crandall, Marie

PY - 2019/11/1

Y1 - 2019/11/1

N2 - Background: Conflicting data on the microbiology and epidemiology of necrotizing soft tissue infections (NSTIs) appear to stem from the heterogeneity in microbiology observed in regions across the United States. Our goal was to determine current differences in organism prevalence and outcomes for NSTI and non-necrotizing severe soft tissue infections across the United States. We hypothesized that there were geographical differences in organism prevalence that would lead to differences in outcomes. Materials and Methods: This study was a retrospective multi-institutional trial from centers across the United States and Canada. Demographic, clinical, and outcomes data were collected. Bivariate and multivariable analyses were performed to determine the effects of region and microbiology on outcomes. Results: A total of 622 patients were included in this study. Polymicrobial infections (45%) were the most prevalent infections in all regions. On bivariate analysis, Clostridium and polymicrobial infections had higher mean Laboratory Risk Indicator for Necrotizing Fasciitis scores and American Association for the Surgery of Trauma grades (P < 0.001 for both) than other organisms. Patients in the South were more likely to be uninsured and had worse unadjusted outcomes. In a risk-adjusted model, increasing American Association for the Surgery of Trauma grade was predictive of mortality (OR, 2.3; 95% CI, 1.6–3.1; P < 0.001), as was age ≥ 55 y (OR 2.7, 95% CI 1.3–5.3, P = 0.006), but region and organism type were not associated with mortality. Conclusions: We found important regional differences with respect to organism type and demographics. However, on risk-adjusted models, neither region nor organism type predicted mortality.

AB - Background: Conflicting data on the microbiology and epidemiology of necrotizing soft tissue infections (NSTIs) appear to stem from the heterogeneity in microbiology observed in regions across the United States. Our goal was to determine current differences in organism prevalence and outcomes for NSTI and non-necrotizing severe soft tissue infections across the United States. We hypothesized that there were geographical differences in organism prevalence that would lead to differences in outcomes. Materials and Methods: This study was a retrospective multi-institutional trial from centers across the United States and Canada. Demographic, clinical, and outcomes data were collected. Bivariate and multivariable analyses were performed to determine the effects of region and microbiology on outcomes. Results: A total of 622 patients were included in this study. Polymicrobial infections (45%) were the most prevalent infections in all regions. On bivariate analysis, Clostridium and polymicrobial infections had higher mean Laboratory Risk Indicator for Necrotizing Fasciitis scores and American Association for the Surgery of Trauma grades (P < 0.001 for both) than other organisms. Patients in the South were more likely to be uninsured and had worse unadjusted outcomes. In a risk-adjusted model, increasing American Association for the Surgery of Trauma grade was predictive of mortality (OR, 2.3; 95% CI, 1.6–3.1; P < 0.001), as was age ≥ 55 y (OR 2.7, 95% CI 1.3–5.3, P = 0.006), but region and organism type were not associated with mortality. Conclusions: We found important regional differences with respect to organism type and demographics. However, on risk-adjusted models, neither region nor organism type predicted mortality.

KW - AAST emergency general surgery grading scale

KW - LRINEC score

KW - Necrotizing soft tissue infections

KW - Skin and soft tissue infections

UR - http://www.scopus.com/inward/record.url?scp=85066407971&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066407971&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2019.05.006

DO - 10.1016/j.jss.2019.05.006

M3 - Article

AN - SCOPUS:85066407971

VL - 243

SP - 108

EP - 113

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

ER -