Intensive multidisciplinary management in critical care patients affected by severe necrotizing soft tissue infections: a cooperative method to improve the efficacy of treatment
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To illustrate the effectiveness of our intensive multidisciplinary management (IMM) in the treatment of severely ill patients with necrotizing soft tissue infections (NSTIs). A retrospective observational study was conducted in a general ICU. Thirty-two consecutive patients undergoing IMM were carefully compared with 30 consecutive patients receiving a standard management (SM). IMM combined intensive care management, early surgical debridement followed by daily inspection of surgical wounds, close microbiological surveillance, and targeted high-dose antibiotics. IMM was associated with the better decrease of daily SOFA score (p = 0.04). Also, IMM caused + 12% increase in the overall number of surgical procedures (p = 0.022) and a higher number of tissue biopsies/per day (median 0.63 versus 0.32; p = 0.025), leading to a more targeted antimicrobial changes (89.6% vs 51.6%; p < 0.00001). High-dose daptomycin (75% vs 36.7%; p = 0.002) and extended/continuous infusion of beta-lactams (75% vs 43.3%; p = 0.011) were more frequently utilized. A specific efficiency score correlated with the decrease of SOFA score (efficacy) in IMM patients only (p = 0.027). Finally, IMM was associated with a significant lower ICU mortality rate (15.6% vs 40%; p = 0.032). IMM was more effective than SM as it allowed the earlier control of infection and the faster reduction of multiple organ-dysfunction.
KeywordsSevere necrotizing soft tissue infections Intensive care unit Intensive multidisciplinary management Targeted antimicrobial therapy Antibiotic de-escalation
In memory of Giovanni Pietro Gesu, for his essential contribution in the implementation of a multidisciplinary task force between microbiologists, infectious disease specialists and intensive care physicians in Niguarda-Ca′ Granda Hospital. Special thanks are due to medical and nursing ICU staff for treating and caring the patient.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with ethical standards
Conflict of interest
Professor Scaglione declares Personal Fees from Pfizer, Novartis, Bayer, and GSK. Other authors have no conflict of interest to declare.
Ethical standard statement
The study was performed in accordance with ethical standards laid down in the 1964 Declarations of Helsinki and its later amendments and with guidelines laid down by the hospital ethics committee.
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