Necrotising Soft Tissue Infection-Risk Factors for Mortality
Necrotising Soft Tissue Infection-Risk Factors for Mortality
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DOI：
10.7860/jcdr/2013/5535.3240
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发表时间：
2013-08-01
影响因子：
0.2
通讯作者：
Indumathi, V. A.
中科院分区：
文献类型：
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作者：
Kalaivani, V;Bharat, V;Indumathi, V. A.
坏死性软组织感染是一种进展迅速的致命性疾病，其预后取决于早期诊断和治疗。目的：本研究旨在探讨影响NSTI死亡率的因素。方法：回顾分析2007年1月至2011年12月所有NSTI患者的临床资料。研究了与死亡率相关的病因、易感因素、危险因素、致病微生物和临床结局。统计数据：由比例(%)组成的描述性统计。生存与死亡危险因素的分布采用卡方检验，差异有统计学意义。结果：共回顾了60例患者的病历。51名患者(85%)为男性，9名(15%)为女性。年龄15~83岁，平均46.57岁(+/-20.60)。所有患者均采用清创及广谱抗生素治疗。单菌培养27例(63.3%)，多菌培养13例(36.7%)，以大肠埃希菌和葡萄球菌为主。在大多数患者中，进行了多次清创。总死亡率估计为25%。年龄、精神病史、糖尿病、低蛋白血症、饮酒、感染部位、细菌学等是影响死亡的危险因素。糖尿病是32例(53.3%)患者中最常见的相关危险因素，尽管在统计学上没有统计学意义。年龄增加(>；50岁，p值=0.016)、血肌酐升高(>；1.2 mg/dl，p值=0.023)和延迟手术治疗(>；24小时p值=0.006)是导致NSTI死亡的危险因素，有统计学意义。结论：尽管使用了适当的抗生素治疗、积极的清创和复苏，NSTI仍导致较高的死亡率和发病率。在本组病例中，随着年龄的增加、血肌酐的升高和手术治疗的延迟，死亡率很高。死亡率(25%)与其他研究相当。
Necrotising Soft Tissue Infection is a rapidly progressing fatal disorder, the prognosis of which depends on early diagnosis and management.Objective: In this study, our objective was to assess the factors contributing to mortality due to NSTI.Methods: A retrospective review of the records of all patients with NSTI involving fascia, skin or muscle between January 2007 and December 2011, was performed. The atiology, predisposing factors, risk factors, causative microbiological organisms and the clinical outcomes associated with mortality were studied.Statistical Data: Descriptive statistics comprising of proportion(%) presented. Chi-square test was employed to assess the statistical significance in the distribution of various known risk factors between the survivors and non- survivors. A 'p' value less than 0.05 was considered significant.Results: Sixty patients records were reviewed. Fifty-one patients (85%) were males and nine (15%) were females. Mean age was 46.57 years (+/-20.60) ranging from 15-83 years. All the patients were treated by debridement & wide spectrum antibiotics. Mono-microbial atiology being found in 27 patients (63.3%) and polymicrobial culture was isolated in 13 patients (36.7%), with E-coli and staphylococci being the most common organisms to be isolated. In most patients, multiple debridements were done. The overall mortality rate was estimated to be 25%. Age, aatiology, diabetes mellitus, hypoalbuminemia, alcohol, site of infection, bacteriology etc. were the risk factors associated with mortality, that were evaluated. Diabetes mellitus was the most common associated risk factor found in 32 patients (53.3%), though not statistically significant. Increasing age (>50 years, p value = 0.016), raised Serum Creatinine (>1.2mg/dl, p-value = 0.023) and delayed surgical intervention(>24 hours p value=0.006) were the risk factors associated with Mortality in NSTI that were statistically significant.Conclusion: Despite the use of appropriate antibiotic treatment, aggressive debridement & resuscitation, NSTI still leads to a high mortality & morbidity. In this series, there is high mortality associated with increasing age, raised serum creatinine and delayed surgical intervention. The mortality rate (25%) is comparable with other studies.