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.

Methods

Patients with NSTIs admitted between 2006 and 2017 were compared according to admission before or after bundle implementation (2012–2013). This bundle consisted mainly in (1) the creation of a multidisciplinary task force; (2) management guidelines on empirical antibiotics, intensive care unit admission criteria, a triage algorithm to accelerate operating room access; and (3) an active communication policy. Patient recruitment and management were compared between pre- and post-implementation periods. Main outcome was day 60-censored hospital survival.

Results

Overall, 224 patients were admitted: 60 before, 35 during, and 129 after bundle implementation. Admission after implementation was associated with increased yearly admissions (10 [8–13] vs 30 [24–43] patients/year, p = 0.014) and decreased mortality (30 vs 15%, HR = 0.49 [0.26–0.92]; p = 0.026) but was no longer a protective factor for mortality after adjustment on confounding factors (adjusted HR = 0.90 [0.43–1.88], p = 0.780). There was no significant difference regarding time to surgery (0 [0–1] vs 0 [0–1] days, p = 0.192) or rate of antibiotic treatment within 24 h (98% vs 99%, p > 0.99).

Conclusions

Implementation of a multidisciplinary care bundle for NSTIs was feasible, but in a retrospective study from an already experienced center was not associated with significantly increased survival after adjustment.

中文翻译：

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多学科护理包对坏死性皮肤和软组织感染的影响：一项回顾性队列研究

背景

坏死性皮肤和软组织感染（NSTI）要求及时的医学和外科治疗。护理包对多种紧急干预措施的协调在其他情况下改善了结果。这项研究旨在评估多学科护理捆绑对NSTI患者管理和结局的影响。

方法

根据实施捆绑术之前或之后（2012-2013年）的入院率比较2006年至2017年间入院的NSTI患者。这一工作包主要包括：（1）建立一个多学科的工作队；（2）关于经验性抗生素的管理指南，重症监护病房的入院标准，加速手术室进入的分类算法；（3）积极的沟通政策。在实施前后比较患者的招募和管理情况。主要结局是第60天检查的医院生存率。

结果

总体上，有224例患者被接受：束实施之前60例，35例期间和129例之后。实施后的入院与每年入院增加（10 [8–13] vs 30 [24–43]患者/年，p  = 0.014）和死亡率降低（30 vs 15％，HR = 0.49 [0.26-0.92]）相关；p  = 0.026），但不再是混杂因素调整后的死亡率保护因素（调整后的HR = 0.90 [0.43-1.88]，p  = 0.780）。手术时间（0 [0–1]对比0 [0–1]天，p  = 0.192）或24小时内的抗生素治疗率（98％vs 99％，p  > 0.99）没有显着差异。

结论

为NSTIs实施多学科护理捆绑是可行的，但是在已经有经验的中心进行的回顾性研究中，调整后的生存率并未显着增加。