Impact of prior antibiotic therapy on severe necrotizing soft-tissue infections in ICU patients: results from a French retrospective and observational study

Published on Oct 9, 2021in European Journal of Clinical Microbiology & Infectious Diseases3.267
· DOI :10.1007/S10096-021-04354-8
Sébastien Tanaka6
Estimated H-index: 6
(French Institute of Health and Medical Research),
Michael Thy2
Estimated H-index: 2
(University of Paris)
+ 11 AuthorsPhilippe Montravers62
Estimated H-index: 62
(University of Paris)
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Abstract
Necrotizing soft-tissue infection (NSTI) is a life-threatening pathology that often requires management in intensive care unit (ICU). Therapies consist of early diagnosis, adequate surgical source control, and antimicrobial therapy. Whereas guidelines underline the need for appropriate routine microbiological cultures before starting antimicrobial therapy in patients with suspected sepsis or septic shock, delaying adequate therapy also strongly increases mortality. The aim of the present study was to compare the characteristics and outcomes of patients hospitalized in ICU for NSTI according to their antimicrobial therapy exposure > 24 h before surgery (called the exposed group) or not (called the unexposed group) before surgical microbiological sampling. We retrospectively included 100 consecutive patients admitted for severe NSTI. The exposed group consisted of 23(23%) patients, while 77(77%) patients belonged to the unexposed group. The demographic and underlying disease conditions were similar between the two groups. Microbiological cultures of surgical samples were positive in 84 patients and negative in 16 patients, including 3/23 (13%) patients and 13/77 (17%) patients in the exposed and unexposed groups, respectively (p = 0.70). The distribution of microorganisms was comparable between the two groups. The main antimicrobial regimens for empiric therapy were also similar, and the proportions of adequacy were comparable (n = 60 (84.5%) in the unexposed group vs. n = 19 (86.4%) in the exposed group, p = 0.482). ICU and hospital lengths of stay and mortality rates were similar between the two groups. In conclusion, in a population of severe ICU NSTI patients, antibiotic exposure before sampling did not impact either culture sample positivity or microbiological findings.
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Observational databases are often used to study causal questions. Before being granted access to data or funding, researchers may need to prove that "the statistical power of their analysis will be high." Analyses expected to have low power, and hence result in imprecise estimates, will not be approved. This restrictive attitude towards observational analyses is misguided. A key misunderstanding is the belief that the goal of a causal analysis is to "detect" an effect. Causal effects are not bin...
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Introduction: Recent studies described the threat of emerging multidrug-resistant (MDR) bacteria in intensive care unit (ICU) patients, but few data are available for necrotizing skin and soft tissue infections (NSTI). In a cohort of ICU patients admitted for NSTI, we describe the dynamic changes of microbial population during repeated surgeries. Materials and Methods: This retrospective study compiled consecutive cases admitted for the management of severe NSTI. Clinical characteristics, NSTI f...
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#1Evan J Zasowski (Touro University California)H-Index: 8
#2Matteo BassettiH-Index: 81
Last. Stefano Aliberti (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico)H-Index: 52
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Abstract Background Patients with severe bacterial infections often experience delay in receiving appropriate treatment. Consolidated evidence of the impact of delayed appropriate treatment is needed to guide treatment and improve outcomes. Research Question.What is the impact of delayed appropriate antibacterial therapy on clinical outcomes in patients with severe bacterial infections. Study Design and Methods.Literature searches of MEDLINE and Embase, conducted on 24 July 2018, identified stud...
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#1Charlotte GarretH-Index: 4
#2Emmanuel CanetH-Index: 28
Last. Jean ReignierH-Index: 26
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BACKGROUND Recent guidelines advise against prophylactic antibiotics in patients with necrotizing pancreatitis, advocating instead a step-up drainage and necrosectomy strategy with antibiotics as dictated by microbiological findings. However, prompt antibiotic therapy is recommended in patients with sepsis or septic shock, a possible presentation of infected pancreatic necrosis (IPN). Consequently, in many critically ill patients with IPN, pancreatic samples are collected only after broad-spectr...
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#1Jan J. De Waele (Ghent University Hospital)H-Index: 67
#2Jeroen SchoutenH-Index: 27
Last. Marc Leone (AMU: Aix-Marseille University)H-Index: 62
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Antimicrobial de-escalation (ADE) is defined as the discontinuation of one or more components of combination empirical therapy, and/or the change from a broad-spectrum to a narrower spectrum antimicrobial. It is most commonly recommended in the intensive care unit (ICU) patient who is treated with broad-spectrum antibiotics as a strategy to reduce antimicrobial pressure of empirical broad-spectrum therapy and prevent antimicrobial resistance, yet this has not been convincingly demonstrated in a ...
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#1Leiqing Li (ZJU: Zhejiang University)H-Index: 1
#2Lingcheng Xu (ZJU: Zhejiang University)H-Index: 1
Last. Xuanding Wang (ZJU: Zhejiang University)H-Index: 1
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Background There have been no systematic studies of microbiological differences before and after antibiotics treatment. The aim of this study was to evaluate the effect of prior receipt of antibiotics on the microorganism distribution.
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#1Oddvar Oppegaard (Haukeland University Hospital)H-Index: 10
#2Eivind Rath (Haukeland University Hospital)H-Index: 3
Necrotizing soft tissue infections (NSTIs) are severe, life-threatening infections, and early therapeutic intervention is essential. Prompt administration of potent antimicrobial agents is pivotal, but inadequate empirical therapy is unfortunately common. Optimization of the antibiotic treatment strategy in NSTIs requires consideration of local epidemiology of causative pathogens and antimicrobial resistance patterns, knowledge on common pathogenetic mechanisms in NSTIs, and adaptations to pharm...
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#1M. Peetermans (Guy's and St Thomas' NHS Foundation Trust)H-Index: 1
#2N. de Prost (University of Paris)H-Index: 8
Last. J. J. De Waele (Ghent University Hospital)H-Index: 25
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Abstract Background Necrotizing skin and soft-tissue infections (NSTI) are rare but potentially life-threatening and disabling infections that often require intensive care unit admission. Objectives To review all aspects of care for a critically ill individual with NSTI. Sources Literature search using Medline and Cochrane library, multidisciplinary panel of experts. Content The initial presentation of a patient with NSTI can be misleading, as features of severe systemic toxicity can obscure som...
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#2Camille Hua (University of Paris)H-Index: 6
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Background Necrotizing skin and soft tissue infections (NSTIs) require both prompt medical and surgical treatment. The coordination of multiple urgent interventions by care bundles has improved outcome in other settings. This study aimed to assess the impact of a multidisciplinary care bundle on management and outcome of patients with NSTIs.
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