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Patient’s characteristics and outcomes in necrotising soft-tissue infections: results from a Scandinavian, multicentre, prospective cohort study

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Abstract

Purpose

Necrotising soft-tissue infections (NSTI) are characterised by necrosis, fast progression, and high rates of morbidity and mortality, but our knowledge is primarily derived from small prospective studies and retrospective studies.

Methods

We performed an international, multicentre, prospective cohort study of adults with NSTI describing patient’s characteristics and associations between baseline variables and microbiological findings, amputation, and 90-day mortality.

Results

We included 409 patients with NSTI; 402 were admitted to the ICU. Cardiovascular disease [169 patients (41%)] and diabetes [98 (24%)] were the most common comorbidities; 122 patients (30%) had no comorbidity. Before surgery, bruising of the skin [210 patients (51%)] and pain requiring opioids [172 (42%)] were common. The sites most commonly affected were the abdomen/ano-genital area [140 patients (34%)] and lower extremities [126 (31%)]. Monomicrobial infection was seen in 179 patients (44%). NSTI of the upper or lower extremities was associated with monomicrobial group A streptococcus (GAS) infection, and NSTI located to the abdomen/ano-genital area was associated with polymicrobial infection. Septic shock [202 patients (50%)] and acute kidney injury [82 (20%)] were common. Amputation occurred in 22% of patients with NSTI of an extremity and was associated with higher lactate level. All-cause 90-day mortality was 18% (95% CI 14–22); age and higher lactate levels were associated with increased mortality and GAS aetiology with decreased mortality.

Conclusions

Patients with NSTI were heterogeneous regarding co-morbidities, initial symptoms, infectious localisation, and microbiological findings. Higher age and lactate levels were associated with increased mortality, and GAS infection with decreased mortality.

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Acknowledgements

The INFECT study group includes: Daniel Bidstrup, Nina F. Bærnthsen, Gladis H. Frendø, Erik C. Jansen, Lærke B. Madsen, Rasmus B. Müller, Emilie M. J. Pedersen, Marie W. Petersen: http://orcid.org/0000-0003-1127-9599, Frederikke Ravn, Isabel F. G. Smidt-Nielsen, Anna M. Wahl, Sandra Wulffeld, Sara Aronsson, Anders Rosemar, Joakim Trogen, Torbjørn Nedrebø, Oddvar Oppegaard, Eivind Rath, and Marianne Sævik. Author affiliations are given in the ESM.

This work is part of the INFECT programme, supported by the European Union’s Seventh Framework Programme under the Grant agreement 305340. We are grateful to patients and relatives for their consent to participate, and to the clinical staff and research staff at the study sites for their important contributions.

Author information

Authors and Affiliations

  1. Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Martin Bruun Madsen & Anders Perner

  2. Department of Medicine, Haukeland University Hospital, Bergen, Norway

    Steinar Skrede & Trond Bruun

  3. Department of Clinical Science, University of Bergen, Bergen, Norway

    Steinar Skrede

  4. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Anders Perner & Ole Hyldegaard

  5. Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden

    Per Arnell & Anders Rosén

  6. Department of Anaesthesia, Surgical Services and Intensive Care, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden

    Michael Nekludov

  7. Department of Anaesthesia and Intensive Care, Blekinge County Hospital, Karlskrona, Sweden

    Ylva Karlsson

  8. Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

    Marco Bo Hansen, Peter Polzik, Morten Hedetoft & Ole Hyldegaard

  9. Laboratory of Systems and Synthetic Biology, Wageningen University and Research, Wageningen, The Netherlands

    Edoardo Saccenti & Vitor A. P. Martins dos Santos

  10. LifeGlimmer GmBH, Berlin, Germany

    François Bergey & Vitor A. P. Martins dos Santos

  11. Centre for Infectious Medicine, Karolinska Institute, Karolinska University Hospital, Huddinge, Sweden

    Anna Norrby-Teglund

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  1. Martin Bruun Madsen
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Consortia

INFECT study group

  • Daniel Bidstrup
  • , Nina F. Bærnthsen
  • , Gladis H. Frendø
  • , Erik C. Jansen
  • , Lærke B. Madsen
  • , Rasmus B. Müller
  • , Emilie M. J. Pedersen
  • , Marie W. Petersen
  • , Frederikke Ravn
  • , Isabel F. G. Smidt-Nielsen
  • , Anna M. Wahl
  • , Sandra Wulffeld
  • , Sara Aronsson
  • , Anders Rosemar
  • , Joakim Trogen
  • , Torbjørn Nedrebø
  • , Oddvar Oppegaard
  • , Eivind Rath
  •  & Marianne Sævik

Contributions

SS, AP, ECJ, TB, ANT, and OH contributed to the conception and the design of the study. MBM, SS, PA, MN, TB, MBH, PP, MH, AR, DB, NFB, GHF, LBM, RM, EMJP, FR, IFGSM, AMW, SW, SA, JT, TN, OO, and ER were involved in the acquisition of data. MBM, SS, AP, TB, ES, FB, VAPMS, ANT, and OH contributed to analysis or interpretation of data or both. MBM, AP, and OH were involved in drafting the manuscript. MBM, SS, AP, MN, TB, MBH, AR, ES, VAPMS, NFB, OO, ER, ANT, and OH critically revised the manuscript. All authors approved the final version for submission.

Corresponding author

Correspondence to Martin Bruun Madsen.

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Conflicts of interest

The Department of Intensive Care, Rigshospitalet, has received research funds from CSL Behring, Switzerland, Fresenius Kabi, Germany, and Ferring Pharmaceuticals, Denmark.

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Madsen, M.B., Skrede, S., Perner, A. et al. Patient’s characteristics and outcomes in necrotising soft-tissue infections: results from a Scandinavian, multicentre, prospective cohort study. Intensive Care Med 45, 1241–1251 (2019). https://doi.org/10.1007/s00134-019-05730-x

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  • DOI: https://doi.org/10.1007/s00134-019-05730-x

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