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 language | English (US) |
|---|---|
| Pages (from-to) | 108-113 |
| Number of pages | 6 |
| Journal | Journal of Surgical Research |
| Volume | 243 |
| DOIs | |
| State | Published - Nov 1 2019 |
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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 journal › Article
}
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 -