Table 3.
Clinical Features, Treatment, and Outcome in NSTI Caused by GAS or SD
| GAS N = 126 | SD N = 27 | P value | |
|---|---|---|---|
| Preoperative symptoms/signs | |||
| Pain treated with opioids | 55/122 (45) | 10/24 (42) | .758 |
| Skin bullae | 47/124 (38) | 6/26 (23) | .150 |
| Purple/black skin discoloration | 47/125 (38) | 12/26 (46) | .416 |
| Skin bruising | 78/124 (63) | 15/25 (60) | .785 |
| Skin anesthesia | 6/94 (6) | 1/23 (4) | 1.000 |
| Preoperative biochemistrya | |||
| CRP (mg/L)b | 295 (193–370) | 261 (148–339) | .131 |
| Leukocytes (x 109/L)c | 14.2 (8.2–22.2) | 16.9 (11.2–23.7) | .393 |
| Creatinine (μM)d | 178 (109–266) | 103 (73–181) | .001 |
| Severity | |||
| Septic shocke | 82/126 (65) | 11/27 (41) | .019 |
| SAPS II (0–163)f | 44 (34–57) | 44 (36–58) | .758 |
| SOFA score day 1 (0–20)g | 9 (7–12) | 8 (6–11) | .129 |
| LRINEC score (0–13)h | 8 (7–10) | 8 (6–9) | .148 |
| LRINEC score ≥ 6h | 90/104 (87) | 19/24 (79) | .352 |
| Muscle affectedi | 83/126 (66) | 14/27 (52) | .170 |
| Antibiotic treatment | |||
| Clindamycin before inclusionj | 89/126 (71) | 23/27 (85) | .121 |
| Betalactam + clindamycink | 122/126 (97) | 25/27 (93) | .286 |
| IVIGl | 95/126 (75) | 16/27 (59) | .088 |
| Hyperbaric oxygen at any time | 94/126 (75) | 21/27 (78) | .729 |
| Mechanical ventilationk,m | 116/126 (92) | 24/27 (89) | .702 |
| Surgeryn | |||
| Time from first admission to first surgery (hours) | 16 (6–29) | 22 (6–42) | .242 |
| Time from first admission to admission at referral hospital (hours) | 18 (6–36) | 14 (5–31) | .441 |
| Time between 1st and 2nd surgery (hours) | 11 (6–20) | 9 (5–14) | .165 |
| Number of operations | 4 (3–5) | 4 (3–5) | .636 |
| Outcome | |||
| Amputationn | 20/126 (16) | 3/27 (11) | .809 |
| 30-day CFR | 13/125 (10) | 5/27 (19) | .320 |
| 90-day CFR | 13/125 (10) | 6/27 (22) | .110 |
Data are presented as median (interquartile range) or no./No. evaluated (%). Boldface indicates statistical significance (P < .05).
Abbreviations: CFR, case-fatality-rate; GAS, group A Streptococcus, Streptococcus pyogenes; IVIG, intravenous polyspesific immunoglobulin G; LRINEC, laboratory risk indicator for necrotizing fasciitis; NSTI, necrotizing soft tissue infection; SAPS, simplified acute physiology score; SD, Streptococcus dysgalactiae; SOFA, sequential organ failure assessment.
aHighest values observed.
bData missing for 5 patients.
cData missing for 7 patients.
dData missing for 9 patients.
eDefined by use of vasopressor or inotropic agents and lactate >2 mmol/L.
fSAPS II is calculated the first 24 hours in the intensive care unit/high-dependency unit from 17 variables; scores range from 0 to 163, with higher scores indicating more severe disease. Data were missing for 16 patients.
gSOFA score includes subscores ranging from 0 to 4 for each of 5 components (circulation, lungs, liver, kidneys, and coagulation). Aggregated scores range from 0 to 20, with higher scores indicating more severe organ failure. The scoring was modified because cerebral failure was not assessed. Data were missing for 3 patients.
hData were missing for 25 patients.
iAssessed during surgery in the primary hospital or during first 7 days of stay at intensive care unit or high-dependency unit at specialized hospital.
jClindamycin given before admission to intensive care unit/high-dependency unit of the study hospital.
kDuring first 7 days of stay at intensive care unit or high-dependency unit.
lAny dosage. The median number of doses among those receiving IVIG was 3 (interquartile range 2–3).
mIntubated patient or continuous noninvasive ventilation.
nAt primary hospital or during first 7 days of stay at intensive care unit or high-dependency unit at study hospital. Any body part.