Dynamic Changes in Microbial Composition During Necrotizing Soft-Tissue Infections in ICU Patients
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...
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Frontiers Media S.A.
2021-03-01
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Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2020.609497/full |
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language |
English |
format |
Article |
sources |
DOAJ |
author |
Michael Thy Michael Thy Sébastien Tanaka Sébastien Tanaka Alexy Tran-Dinh Alexy Tran-Dinh Alexy Tran-Dinh Lara Ribeiro Lara Ribeiro Brice Lortat-Jacob Julia Donadio Nathalie Zappella Mouna Ben-Rehouma Mouna Ben-Rehouma Parvine Tashk Aurelie Snauwaert Enora Atchade Nathalie Grall Nathalie Grall Nathalie Grall Philippe Montravers Philippe Montravers Philippe Montravers |
spellingShingle |
Michael Thy Michael Thy Sébastien Tanaka Sébastien Tanaka Alexy Tran-Dinh Alexy Tran-Dinh Alexy Tran-Dinh Lara Ribeiro Lara Ribeiro Brice Lortat-Jacob Julia Donadio Nathalie Zappella Mouna Ben-Rehouma Mouna Ben-Rehouma Parvine Tashk Aurelie Snauwaert Enora Atchade Nathalie Grall Nathalie Grall Nathalie Grall Philippe Montravers Philippe Montravers Philippe Montravers Dynamic Changes in Microbial Composition During Necrotizing Soft-Tissue Infections in ICU Patients Frontiers in Medicine necrotizing soft-tissue infections (NSTI) intensive care unit (ICU) sepsis multidrug-resistant (MDR) bacteria outcome antimicrobial therapy |
author_facet |
Michael Thy Michael Thy Sébastien Tanaka Sébastien Tanaka Alexy Tran-Dinh Alexy Tran-Dinh Alexy Tran-Dinh Lara Ribeiro Lara Ribeiro Brice Lortat-Jacob Julia Donadio Nathalie Zappella Mouna Ben-Rehouma Mouna Ben-Rehouma Parvine Tashk Aurelie Snauwaert Enora Atchade Nathalie Grall Nathalie Grall Nathalie Grall Philippe Montravers Philippe Montravers Philippe Montravers |
author_sort |
Michael Thy |
title |
Dynamic Changes in Microbial Composition During Necrotizing Soft-Tissue Infections in ICU Patients |
title_short |
Dynamic Changes in Microbial Composition During Necrotizing Soft-Tissue Infections in ICU Patients |
title_full |
Dynamic Changes in Microbial Composition During Necrotizing Soft-Tissue Infections in ICU Patients |
title_fullStr |
Dynamic Changes in Microbial Composition During Necrotizing Soft-Tissue Infections in ICU Patients |
title_full_unstemmed |
Dynamic Changes in Microbial Composition During Necrotizing Soft-Tissue Infections in ICU Patients |
title_sort |
dynamic changes in microbial composition during necrotizing soft-tissue infections in icu patients |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Medicine |
issn |
2296-858X |
publishDate |
2021-03-01 |
description |
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 features, morbidity and mortality data were collected. The microbiological characteristics of surgical samples obtained during initial surgery were compared with those obtained during the first reoperation, including persistence of initial pathogens and/or emergence of microorganisms. Risk factors for emergence of microorganisms and MDR bacteria were assessed by univariable and multivariable analyses.Results: Among 100 patients {63% male, 58 years old [interquartile ratio (IQR) 50–68]} admitted for NSTI, 54 underwent reoperation with a median [IQR] delay of 3 (1–7) days. Decreased proportions of susceptible strains and emergence of Gram-negative bacteria, including Pseudomonas aeruginosa, staphylococci and enterococci strains, were reported based on the cultures of surgical specimen collected on reoperation. On reoperation, 22 (27%) of the isolated strains were MDR (p < 0.0001 vs. MDR bacteria cultured from the first samples). Broad-spectrum antibiotic therapy as first-line therapy was significantly associated with a decreased emergence of microorganisms. Adequate antibiotic therapy from the initial surgery did not modify the frequency of emergence of microorganisms (p = 0.79) and MDR bacteria (p = 1.0) or the 1-year survival rate.Conclusion: The emergence of microorganisms, including MDR bacteria, is frequently noted in NSTI without affecting mortality. |
topic |
necrotizing soft-tissue infections (NSTI) intensive care unit (ICU) sepsis multidrug-resistant (MDR) bacteria outcome antimicrobial therapy |
url |
https://www.frontiersin.org/articles/10.3389/fmed.2020.609497/full |
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doaj-4f1d204e54a84064ad318dbf89a0339a2021-03-04T04:52:47ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-03-01710.3389/fmed.2020.609497609497Dynamic Changes in Microbial Composition During Necrotizing Soft-Tissue Infections in ICU PatientsMichael Thy0Michael Thy1Sébastien Tanaka2Sébastien Tanaka3Alexy Tran-Dinh4Alexy Tran-Dinh5Alexy Tran-Dinh6Lara Ribeiro7Lara Ribeiro8Brice Lortat-Jacob9Julia Donadio10Nathalie Zappella11Mouna Ben-Rehouma12Mouna Ben-Rehouma13Parvine Tashk14Aurelie Snauwaert15Enora Atchade16Nathalie Grall17Nathalie Grall18Nathalie Grall19Philippe Montravers20Philippe Montravers21Philippe Montravers22Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, FranceEA 7323 - Pharmacology and Therapeutic Evaluation in Children and Pregnant Women, Paris Descartes University, Sorbonne Paris Cité University, Paris, FranceAssistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, FranceRéunion Island University, French Institute of Health and Medical Research (INSERM), U1188 Diabetes atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Saint-Denis de La Réunion, FranceAssistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, FranceUniversité de Paris, UFR Denis Diderot, Paris, FranceFrench Institute of Health and Medical Research (INSERM) U1148, Laboratory for Vascular Translational Science, Paris, FranceUniversité de Paris, UFR Denis Diderot, Paris, FranceAssistance Publique - Hôpitaux de Paris (AP-HP), Department of General and Visceral Surgery, Bichat-Claude Bernard Hospital, Paris, FranceAssistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, FranceAssistance Publique - Hôpitaux de Paris (AP-HP), Department of Orthopedic Surgery, Bichat-Claude Bernard Hospital, Paris, FranceAssistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, FranceAssistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, FranceParis-Saclay University, French Institute of Health and Medical Research, INSERM UMR 1195, Le Kremlin-Bicêtre, FranceAssistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, FranceAssistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, FranceAssistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, FranceUniversité de Paris, UFR Denis Diderot, Paris, FranceAssistance Publique - Hôpitaux de Paris (AP-HP), Department of Bacteriology, Bichat-Claude Bernard Hospital, Paris, France0French Institute of Health and Medical Research (INSERM), IAME, UMR 1137, Paris, FranceAssistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, FranceUniversité de Paris, UFR Denis Diderot, Paris, France1French Institute of Health and Medical Research (INSERM) U1152, Physiopathology and Epidemiology of Respiratory Diseases, Paris, FranceIntroduction: 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 features, morbidity and mortality data were collected. The microbiological characteristics of surgical samples obtained during initial surgery were compared with those obtained during the first reoperation, including persistence of initial pathogens and/or emergence of microorganisms. Risk factors for emergence of microorganisms and MDR bacteria were assessed by univariable and multivariable analyses.Results: Among 100 patients {63% male, 58 years old [interquartile ratio (IQR) 50–68]} admitted for NSTI, 54 underwent reoperation with a median [IQR] delay of 3 (1–7) days. Decreased proportions of susceptible strains and emergence of Gram-negative bacteria, including Pseudomonas aeruginosa, staphylococci and enterococci strains, were reported based on the cultures of surgical specimen collected on reoperation. On reoperation, 22 (27%) of the isolated strains were MDR (p < 0.0001 vs. MDR bacteria cultured from the first samples). Broad-spectrum antibiotic therapy as first-line therapy was significantly associated with a decreased emergence of microorganisms. Adequate antibiotic therapy from the initial surgery did not modify the frequency of emergence of microorganisms (p = 0.79) and MDR bacteria (p = 1.0) or the 1-year survival rate.Conclusion: The emergence of microorganisms, including MDR bacteria, is frequently noted in NSTI without affecting mortality.https://www.frontiersin.org/articles/10.3389/fmed.2020.609497/fullnecrotizing soft-tissue infections (NSTI)intensive care unit (ICU)sepsismultidrug-resistant (MDR) bacteriaoutcomeantimicrobial therapy |