Abstract
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.
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Acknowledgements
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.
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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Professor Scaglione declares Personal Fees from Pfizer, Novartis, Bayer, and GSK. Other authors have no conflict of interest to declare.
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Gatti, M., Gasparini, L.E., Laratta, M. et al. Intensive multidisciplinary management in critical care patients affected by severe necrotizing soft tissue infections: a cooperative method to improve the efficacy of treatment. Eur J Clin Microbiol Infect Dis 38, 1153–1162 (2019). https://doi.org/10.1007/s10096-019-03521-2
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DOI: https://doi.org/10.1007/s10096-019-03521-2