Annals of Intensive Care (Apr 2023)

Necrotizing soft tissue infections in critically ill neutropenic patients: a French multicentre retrospective cohort study

  • Romain Arrestier,
  • Anis Chaba,
  • Asma Mabrouki,
  • Clément Saccheri,
  • Emmanuel Canet,
  • Marc Pineton de Chambrun,
  • Annabelle Stoclin,
  • Muriel Picard,
  • Florent Wallet,
  • François Perier,
  • Matthieu Turpin,
  • Laurent Argaud,
  • Maxens Decavèle,
  • Nahéma Issa,
  • Cyril Cadoz,
  • Kada Klouche,
  • Johana Cohen,
  • Djamel Mokart,
  • Julien Grouille,
  • Tomas Urbina,
  • Camille Hua,
  • Olivier Chosidow,
  • Armand Mekontso-Dessap,
  • Elie Azoulay,
  • Nicolas de Prost

DOI
https://doi.org/10.1186/s13613-023-01125-w
Journal volume & issue
Vol. 13, no. 1
pp. 1 – 9

Abstract

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Abstract Background Necrotizing soft tissue infections (NSTIs) are rare life-threatening bacterial infections. Few data are available regarding neutropenic patients with NSTIs. Our objectives were to describe the characteristics and management of neutropenic patients with NSTIs in intensive care units (ICUs). We conducted a retrospective multicentre cohort study in 18 ICUs between 2011 and 2021. Patients admitted with NSTIs and concomitant neutropenia at diagnosis were included and compared to non-neutropenic patients with NSTIs. The relationship between therapeutic interventions and outcomes was assessed using Cox regression and propensity score matching. Results 76 neutropenic patients were included and compared to 165 non-neutropenic patients. Neutropenic patients were younger (54 ± 14 vs 60 ± 13 years, p = 0.002) and had less lower limb (44.7% vs 70.9%, p < 0.001) and more abdomino-perineal NSTIs (43.4% vs 18.8%, p < 0.001). Enterobacterales and non-fermenting gram-negative bacteria were the most frequently isolated microorganisms in neutropenic patients. In-hospital mortality was significantly higher in neutropenic than in non-neutropenic patients (57.9% vs 28.5%, p < 0.001). Granulocyte colony-stimulating factor (G-CSF) administration was associated with a lower risk of in-hospital mortality in univariable Cox (hazard ratio (HR) = 0.43 95% confidence interval (CI) [0.23–0.82], p = 0.010) and multivariable Cox (adjusted HR = 0.46 95% CI [0.22–0.94], p = 0.033) analyses and after overlap propensity score weighting (odds ratio = 0.25 95% CI [0.09; 0.68], p = 0.006). Conclusions Critically ill neutropenic patients with NSTIs present different clinical and microbiological characteristics and are associated with a higher hospital mortality than non-neutropenic patients. G-CSF administration was associated with hospital survival.

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