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The Prediction Predicament: Rethinking Necrotizing Soft Tissue Infections Mortality

机译:预测困境:重新思考坏死性软组织感染的死亡率

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Background: Our study sought to identify independent risk factors predisposing patients with necrotizing soft tissue infections (NSTIs) to mortality from among laboratory values, demographic data, and microbiologic findings in a small population. To this end, a retrospective review was conducted of the medical records of all patients with NSTI who had been treated at our institution from 2003 to 2012 (n=134). Methods: Baseline demographics and comorbidities, clinical and laboratory values, hospital course, and the microbiologic characteristics of surgical incision cultures were recorded. Each variable was tested for association with survival status and all associated variables with p<0.15 were included in a logistic regression model to seek factors associated independently with mortality. Results: Surprisingly, no demographic or pre-existing condition proved to be a predictor of mortality. Two laboratory values had an inverse correlation to mortality: High C-reactive protein (CRP) and highest recorded CRP. Of surgical incisions that grew bacteria in culture, 33.6% were polymicrobial. Mortality rates were highest with Enterococcus-containing polymicrobial infections (50%), followed by those containing Pseudomonas (40%), and Streptococcus spp. (27%). Understanding why so many studies across the literature, now including our own, find such disparate results for correlation of NSTI mortality with patient data may lie in the fundamentally dynamic nature of the organisms involved. Conclusions: This study suggests that no single factor present on admission is a robust predictor of outcome; it is likely that survival in NSTI is predicated upon a complex interaction of multiple host and microbial factors that do not lend themselves to reduction into a simple formula. It is also abundantly clear that the well-established principles of NSTI surgery should continue to be followed in all cases, with an emphasis on early debridement, irrespective of apparent severity of initial presentation.
机译:背景:我们的研究试图从实验室价值,人口统计数据和一小部分微生物学发现中确定独立的危险因素,使易坏死性软组织感染(NSTIs)的患者死亡。为此,我们对2003年至2012年间在本院接受治疗的所有NSTI患者的病历进行了回顾性审查(n = 134)。方法:记录基线人口统计和合并症,临床和实验室值,医院病程以及手术切口培养物的微生物学特征。测试每个变量与生存状态的关联,并将所有p <0.15的关联变量包括在logistic回归模型中,以寻求与死亡率独立相关的因素。结果:令人惊讶的是,没有人口统计学或既往病情可预测死亡。有两个实验室值与死亡率呈负相关:高C反应蛋白(CRP)和最高记录CRP。在培养物中生长细菌的手术切口中,有33.6%是微生物。死亡率最高的是含有肠球菌的微生物感染(50%),其次是含有假单胞菌的细菌(40%)和链球菌。 (27%)。理解为什么现在有包括我们自己在内的众多文献研究发现如此不同的结果来将NSTI死亡率与患者数据相关联,可能在于所涉生物体具有根本的动态性质。结论:这项研究表明,入院时没有单一因素可以作为预测结局的可靠指标。 NSTI的存活可能取决于多种宿主和微生物因素之间的复杂相互作用,而这些因素本身并不能简化为一个简单的公式。同样非常清楚的是,在所有情况下都应继续遵循既定的NSTI手术原则,并强调尽早进行清创术,而不论最初表现的严重程度如何。

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  • 来源
    《Surgical infections》 |2015年第6期|813-821|共9页
  • 作者单位

    Texas Tech Univ, Hlth Sci Ctr, Dept Surg, Lubbock, TX 79430 USA;

    Texas Tech Univ, Hlth Sci Ctr, Dept Surg, Lubbock, TX 79430 USA;

    Texas Tech Univ, Dept Math & Stat, Lubbock, TX 79430 USA;

    Texas Tech Univ, Hlth Sci Ctr, Dept Surg, Lubbock, TX 79430 USA;

  • 收录信息 美国《化学文摘》(CA);
  • 原文格式 PDF
  • 正文语种 eng
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