A Multi-Center Review of Care Patterns and Outcomes in Necrotizing Soft Tissue Infections.
BACKGROUND
Surgical debridement and broad-spectrum empiric antibiotics are first-line therapy for necrotizing soft tissue infections (NSTI). The objective of this multi-center retrospective review was to evaluate antimicrobial agent initiation and duration and compare outcomes in the treatment of patients with NSTI.


METHODS
This review included adults with NSTI, as indicated by International Classification of Diseases, 9th Edition, Clinical Modification codes 728.86, 608.33, or 040.0, who were admitted to three academic institutions between 1/1/09 and 5/15/14. Demographics, antibiotic practices, operative management, and clinical outcomes were compared.


RESULTS
A total of 341 patients were identified at the three centers. Subjects were comparable in age (median 53 years, p = 0.14), gender (67% male, p = 0.57) and body mass index (median 31.9 (p = 0.31) between sites. No significant difference was found in time from admission to start of empiric antibiotic therapy between the three centers (median 1 d for each, p = 0.70), but duration of antibiotic therapy was significantly different (Site A = 16 d, Site B = 12 d, Site C = 9 d, medians, p < 0.001). Although total number of operations differed between sites (median of two at Sites A and B, three at Site C, p = 0.001), sites consistently operated on the day of patient arrival to their facility, and the number of debridements did not differ (median of two for all sites, p = 0.10). Mortality rate (Site A = 22%, Site B = 18%, and Site C = 9%, p = 0.02) and length of stay for survivors (Site A = 29 d, Site B = 16 d, Site C = 19 d, medians, p = 0.001) was significantly different among centers.


CONCLUSIONS
Variation in antibiotic duration between centers with expertise in the care of NSTI illustrates how little is known about best care practices for patients with NSTI. Future studies should emphasize development of evidence-based practices for NSTI management to further improve the outcomes of this complex group of patients.
1 Department of Surgery, University of Utah , Salt Lake City, Utah.
Iris
I
Faraklas
2 Department of Surgery, Texas Tech University Health Sciences Center , Lubbock, Texas.
Derek
D
Yang
3 Department of Surgery, Loyola University Stritch School of Medicine , Maywood, Illinois.
Michael
M
Eggerstedt
1 Department of Surgery, University of Utah , Salt Lake City, Utah.
Yan
Y
Zhai
1 Department of Surgery, University of Utah , Salt Lake City, Utah.
Patrick
P
Liebel
1 Department of Surgery, University of Utah , Salt Lake City, Utah.
Gareth
G
Graves
2 Department of Surgery, Texas Tech University Health Sciences Center , Lubbock, Texas.
Sharmila
S
Dissanaike
3 Department of Surgery, Loyola University Stritch School of Medicine , Maywood, Illinois.
Michael
M
Mosier
1 Department of Surgery, University of Utah , Salt Lake City, Utah.
Amalia
A
Cochran
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019115:Fasciitis, Necrotizing / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
antibiotic therapy; necrotizing fasciitis; necrotizing soft tissue infection; outcomes