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LOCAL VARIATIONS IN EPIDEMIOLOGY, MICROBIOLOGY, AND OUTCOME OF NECROTIZING SOFT TISSUE INFECTIONS: A MULTI-CENTER STUDY Lillian S Kao, MD, MPH, Debbie F Lew, MPH, Samer N Arab, MD, S. Rob Todd, MD, Matthew M Carrick, MD, Michael G Corneille, MD, Samir S Awad, MD, Kevin P Lally, MD, MS, University of Texas Health Science Center at Houston
Background: Necrotizing soft tissue infections (NSTIs) are rare and highly lethal. An increasing proportion of monomicrobial MRSA infections may be associated with improved outcomes. Methods: Retrospective chart review of patients with NSTIs treated at 6 academic hospitals (3 county, 2 private, and 1 VA) in Texas (5 in Houston, 1 in San Antonio) between January 1, 2004 and December 31, 2007. Patient demographics, presentation, microbiology, treatment, and outcome were recorded. Analysis of variance, chi-square, and logistic regression analysis were performed. Results: A total of 296 patients had documented NSTIs (see table). Over half of the infections were monomicrobial (54%), with the most common single pathogen being MRSA. There was a significant difference in the percentage of monomicrobial MRSA infections between hospitals. The etiologies differed significantly between the centers as well; i.e. MRSA infections were associated with intravenous injections and bites. The overall mortality and amputation rates were 16.6% and 8.8% respectively. Among the hospitals, the lowest rates were associated with higher proportions of MRSA. On univariate analysis, monomicrobial Staphylococcal infections had an OR of 0.32 (95% 0.10-1.07, p=0.65) for mortality. On multiple regression, independent predictors of mortality included age, shock requiring vasopressors, and renal failure post-operatively. Conclusion: Patients with monomicrobial MRSA NSTIs are becoming increasingly common and have improved outcomes compared to other types of NSTIs. Significant differences occur in the etiology, microbiology, and patient outcomes of NSTIs, even within a concentrated region. Collaborative efforts are required to perform multicenter trials of adjunct treatments to improve outcome.
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