C. Hua

Prognostic factors in necrotizing soft-tissue infections (NSTI): A cohort study

BACKGROUND Necrotizing soft-tissue infection (NSTI) is uncommon but life-threatening. A recent meta-analysis estimated the overall mortality at 23.5%. OBJECTIVE We sought to identify risk factors associated with mortality in a cohort of patients with NSTI in a tertiary care center. METHODS We identified 512 patients with NSTI between 1996 and 2012 in the national hospital database Program for Medicalization of Information Systems and examined risk factors of mortality with NSTI by univariate and multivariate analysis. RESULTS We included 109 patients with a confirmed diagnosis of NSTI; 31 (28%) died at a median follow-up of 274 days (range 2-6135 days). On multivariate analysis, independent risk factors of mortality were age older than 75 years (hazard ratio [HR] 4.4, 95% confidence interval [CI] 1.8-10.3), multifocal NSTI (HR 5.9, 95% CI 1.9-18.5), severe peripheral vascular disease (HR 5.1, 95% CI 1.5-17.0), hospital-acquired infection (HR 3.9, 95% CI 1.4-10.7), severe sepsis (HR 7.4, 95% CI 1.7-33.1), and septic shock on hospital admission (HR 13.9, 95% CI 3.8-50.4). LIMITATIONS This was a retrospective cohort, which disallows a precise record of the delay between diagnosis and surgery. CONCLUSION Our findings for this robust cohort of patients with a definite diagnosis of NSTI could help clinicians stratify NSTI severity at clinical course onset.

Epidermal necrolysis and autoimmune diseases: two more observations supporting the concept that ‘toxic’ epidermal necrolysis can be ‘non-toxic’

Toxic epidermal necrolysis (TEN, Lyell syndrome) and Stevens-Johnson syndrome are severe cutaneous adverse reactions to drugs characterized by epidermal necrolysis (EN). However, in 15% of cases, no causative drug is identified. In these cases, other triggers such as Mycoplasma pneumoniae have been described. Furthermore, the role of lupus as triggering factor has been suggested. We report 2 cases of EN without any drug causality, revealing autoimmune diseases as a cause. This article is protected by copyright. All rights reserved.