Fungal Infections Increase the Mortality Rate Three-Fold in Necrotizing Soft-Tissue Infections
| Autor: | Obeid N. Ilahi, Grant V. Bochicchio, Rohit K Rasane, Marlon Torres, Isaiah R. Turnbull, Laurie J. Punch, Christopher B Horn, Brendan M Wesp, Nicholas B Fiore |
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| Rok vydání: | 2017 |
| Předmět: |
Microbiology (medical)
Adult Male medicine.medical_specialty Demographics Population Body Mass Index Continuous variable 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Humans 030212 general & internal medicine Fasciitis Necrotizing Prospective Studies Fasciitis Intensive care medicine education Prospective cohort study Aged education.field_of_study business.industry Mortality rate Soft Tissue Infections Soft tissue Length of Stay Middle Aged medicine.disease Infectious Diseases Mycoses 030220 oncology & carcinogenesis Surgery Female business Body mass index |
| Zdroj: | Surgical infections. 18(7) |
| ISSN: | 1557-8674 |
| Popis: | Necrotizing soft-tissue infections (NSTIs) result in significant morbidity and mortality rates, with as many as 76% of patients dying during their index admission. Published data suggest NSTIs rarely involve fungal infections in immunocompetent patients. However, because of the recent recognition of fungal infections in our population, we hypothesized that such infections frequently complicate NSTIs and are associated with higher morbidity and mortality rates.A prospectively maintained Acute and Critical Care Surgery (ACCS) database spanning 2008-2015 and including more than 7,000 patients was queried for patients with NSTIs. Microbiologic data, demographics, and clinical outcomes were abstracted. Risk factors and outcomes associated with NSTI with positive intra-operative fungal cultures were determined. Frequencies were compared by χA total of 230 patients were found to have NSTIs; 197 had intra-operative cultures, and 21 (10.7%) of these were positive for fungi. Fungal infection was more common in women, patients with higher body mass index (BMI), and patients who had had prior abdominal procedures. There were no significant differences in demographics, co-morbidities, or site of infection. The majority of patients (85.7%) had mixed bacterial and fungal infections; in the remaining patients, fungi were the only species isolated. Most fungal cultures were collected within 48 h of hospital admission, suggesting that the infections were not hospital acquired. Patients with positive fungal cultures required two more surgical interventions and had a three-fold greater mortality rate than patients without fungal infections.This is the largest series to date describing the impact of fungal infection in NSTIs. Our data demonstrate a three-fold increase in the mortality rate and the need for two additional operations. Consideration should be given to starting patients on empiric anti-fungal therapy in certain circumstances. |
| Databáze: | OpenAIRE |
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