by 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
Annals of
Intensive Care volume 13,
Article number: 34 (2023)
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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