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Original research
Polymicrobial and monomicrobial necrotizing soft tissue infections: comparison of clinical, laboratory, radiological, and pathological hallmarks and prognosis. A retrospective analysis
  1. Eviatar Naamany1,
  2. Shachaf Shiber1,2,
  3. Hadar Duskin-Bitan1,3,
  4. Dafna Yahav1,4,
  5. Jihad Bishara1,4,
  6. Iftach Sagy5,6,
  7. Nadav Granat2,
  8. Michael Drescher1,2
  1. 1Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  2. 2Emergency Medicine, Rabin Medical Center, Petah Tikva, Israel
  3. 3Endocrinology, Rabin Medical Center, Petah Tikva, Israel
  4. 4Infectious Disease, Rabin Medical Center, Petah Tikva, Israel
  5. 5Rheumatology, Soroka Medical Center, Beer Sheva, Israel
  6. 6Rheumatology, Rabin Medical Center, Petah Tikva, Israel
  1. Correspondence to Dr Shachaf Shiber; sofereret{at}gmail.com

Abstract

Background Necrotizing soft tissue infection (NSTI) is a life-threatening infection associated with high morbidity and mortality. Treatment consists of surgery and antibiotics. Many studies have addressed NSTI and its subtypes, but few have reviewed the clinical, radiological, and pathological differences between the polymicrobial and monomicrobial diseases. The objective of our study was to evaluate the clinical, radiological, and pathological features of patients with polymicrobial (NSTI I) and monomicrobial (NSTI II) infections and their association with outcome.

Methods The cohort consisted of patients hospitalized with NSTI at a tertiary medical center in 2002–2019. The medical charts were reviewed for clinical, radiological, and pathological features. Findings were compared between patients in whom blood/tissue bacterial cultures yielded one or more than one pathological isolate. The primary clinical outcome measure of the study was all-cause mortality at 90 days. Secondary outcomes were duration of hospitalization, intensive care unit (ICU) admission, score on the LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis), and need for vasopressor treatment.

Results A total of 81 patients met the inclusion criteria: 54 (66.6%) with monomicrobial NSTI and 27 (33.3%) with polymicrobial NSTI. There were no significant between-group differences in in-hospital and 90-day mortality. On multivariate analysis, the monomicrobial disease group had a significantly higher 90-day mortality rate in addition to higher rates of in-hospital mortality, ICU admission, and vasopressor use than the polymicrobial disease group.

Conclusion Our study is the first to compare the clinical, radiological, and pathological differences between the two most common types of NSTI. The results demonstrate better prognosis for polymicrobial NSTI, with minimal ICU stay, lower mortality, and lower use of vasopressors.

Level of evidence Prognostic and epidemiological, level III.

  • intensive care
  • fasciitis
  • necrotizing

Data availability statement

Data are available upon reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2021-000745

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • EN and SS contributed equally.

    • Contributors EN, HD-B, and SS recorded the patient characteristics. SS, JB, and DY wrote the article. IS and NG performed the statistical analysis. MD drafted and critically revised the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.