title: Necrotizing soft-tissue infections in New Caledonia: Epidemiology, clinical presentation, microbiology, and prognostic factors.
abstract: OBJECTIVE
  Necrotizing soft-tissue infections (NSTIs) are severe and rapidly progressive infectious conditions. We herein describe the clinical characteristics, microbiology, and prognosis factors of NSTIs in New Caledonia.
  
  
  METHODS
  All patients admitted for confirmed NSTIs at the only surgical facility in New Caledonia from January 2008 to July 2013 were retrospectively included. Factors associated with mortality were analyzed by multivariate risk regression.
  
  
  RESULTS
  Over the period under review, 67 patients were studied (annual incidence rate, 6.1/year/100,000 inhabitants). The overall mortality rate was 24%. Melanesian people (n = 47; 70%) were more affected than other ethnic groups (n = 20; 30%; p = 0.001). The mean age was 54 years, and men were predominantly affected (n = 46; 69%). The most common comorbidity reported was diabetes mellitus (n = 24; 36%). Nonsteroidal anti-inflammatory intake prior to admission was reported in 14 cases (21%). Lower limbs were the most commonly affected anatomical sites (n = 36; 54%). At least one pathogen was identified in 31 cases (46%), whereas polymicrobial flora was found in 26 cases (39%). No bacteria were isolated in 10 cases (15%). Streptococcus pyogenes was the most frequently isolated bacterium (n = 21; 32%). Factors associated with mortality were use of norepinephrine [odds ratio (OR) 25.6; 95% confidence interval (CI) 4.8-135.8] and presence of two comorbidities (OR 8.6; 95% CI 1.7-42.3).
  
  
  CONCLUSIONS
  NSTIs are particularly frequent in New Caledonia. Local health care workers should have a high index of suspicion for the disease to initiate surgical and medical treatments early.
authors.affiliation: Intensive Care Unit, Centre Hospitalier Territorial, Nouméa, New Caledonia; Department of Anaesthesia and Intensive Care, Cavale Blanche Hospital, Brest, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Kha
authors.affiliation: Institut Pasteur in New Caledonia, Nouméa, New Caledonia.
authors.forename: Julien
authors.initials: J
authors.lastname: Colot
authors.affiliation: Hospital and Patient Data Section, Centre Hospitalier Territorial, Nouméa, New Caledonia.
authors.forename: Shirley
authors.initials: S
authors.lastname: Gervolino
authors.affiliation: Intensive Care Unit, Centre Hospitalier Territorial, Nouméa, New Caledonia; Department of Anaesthesia and Intensive Care, Cochin Hospital, Paris, France. Electronic address: guerriergilles@gmail.com.
authors.forename: Gilles
authors.initials: G
authors.lastname: Guerrier
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis; D009510:New Caledonia / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology
keywords: New Caledonia; Streptococcus pyogenes; diabetes mellitus; necrotizing soft-tissue infection