A 16-year Longitudinal Cohort Study of Incidence and Bacteriology of Necrotising Fasciitis in England.

Autor: Bodansky DMS; The Departments of Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Prescot Street, Liverpool, L7 8XP, UK., Begaj I; Health Informatics and Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK., Evison F; Health Informatics and Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK., Webber M; Quadram Institute Bioscience, Norwich, NR4 7UQ, UK., Woodman CB; Cancer Sciences, University of Birmingham, Birmingham, B15 2SG, UK., Tucker ON; Health Informatics and Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK. o.tucker@bham.ac.uk.
Jazyk: angličtina
Zdroj: World journal of surgery [World J Surg] 2020 Aug; Vol. 44 (8), pp. 2580-2591.
DOI: 10.1007/s00268-020-05559-2
Abstrakt: Background: Necrotising fasciitis (NF) is a rapidly progressive, destructive soft tissue infection with high mortality. The primary aim of this study was to evaluate the incidence and mortality of NF amongst patients admitted to English National Health Service (NHS) hospitals. The secondary aims included the identification of risk factors for mortality and causative pathogens.
Methods: The Hospital Episodes Statistics database identified patients with NF admitted to English NHS Trusts from 1/1/2002 to 31/12/2017. Information on patient demographics, co-morbid conditions, microbiology specimens, surgical intervention and in-hospital mortality was collected. Uni- and multivariable analyses were performed to investigate factors related to in-hospital mortality.
Results: A total of 11,042 patients were diagnosed with NF. Age-standardised incidence rose from 9 per million in 2002 to 21 per million in 2017 (annual percentage change = 6.9%). Incidence increased with age and was higher in men. Age-standardised mortality rate remained at 16% over the study period, while in-hospital mortality declined. On multivariable analysis, the following factors were associated with increased risk of in-hospital mortality: emergency admission, female sex, history of congestive heart failure, peripheral vascular disease, chronic kidney disease and cancer. Admission year and diabetes, which was significantly prevalent at 27%, were not associated with increased risk of mortality. Gram-positive pathogens, particularly Staphylococci, decreased over the study period with a corresponding increase in Gram-negative pathogens, predominantly E. coli.
Conclusion: The incidence of NF increased markedly from 2002 to 2017 although in-hospital mortality did not change. There was a gradual shift in the causative organisms from Gram-positive to Gram-negative.
Databáze: MEDLINE
Externí odkaz: