Intensive multidisciplinary management in critical care patients affected by severe necrotizing soft tissue infections: a cooperative method to improve the efficacy of treatment
| Autor: | Milo Gatti, Laura Elisa Gasparini, Chiara Vismara, Anna Sigurtà, Anna Rossi, Matteo Laratta, Sergio Arlati, Osvaldo Chiara, Francesco Scaglione, Paolo Brioschi |
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| Přispěvatelé: | Gatti M., Gasparini L.E., Laratta M., Sigurta A., Rossi A., Brioschi P., Chiara O., Vismara C., Scaglione F., Arlati S. |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Anti-Infective Agent Male Continuous infusion Organ Dysfunction Scores Severe necrotizing soft tissue infection Antibiotics Organ Dysfunction Score law.invention 0302 clinical medicine Anti-Infective Agents law Retrospective Studie Medicine 030212 general & internal medicine Hospital Mortality Soft tissue Surgical wound General Medicine Middle Aged Necrosi Intensive care unit Intensive Care Units Infectious Diseases SOFA score Female Intensive multidisciplinary management Targeted antimicrobial therapy medicine.drug Human Microbiology (medical) Adult medicine.medical_specialty Critical Care medicine.drug_class 030106 microbiology Intensive Care Unit Antibiotic de-escalation 03 medical and health sciences Necrosis Internal medicine Humans Retrospective Studies Aged business.industry Soft Tissue Infections Retrospective cohort study Debridement Daptomycin business Program Evaluation |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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