Characteristics, treatments, and outcomes of patients with necrotizing soft tissue infections: a Dutch multicenter cohort study

PURPOSE: Necrotizing Soft Tissue Infections (NSTI) are associated with high mortality and morbidity. This study aimed to gain insights into the patient-, disease-, and treatment characteristics, as well as the clinical outcomes of NSTI patients in the Netherlands, contributing to the global knowledge of this disease.

METHODS: This study analyzed the NSTI Knowledge Project cohort, comprising 271 patients who were treated for acute NSTI in 11 hospitals across the Netherlands between 2013 and 2017.

RESULTS: Most patients (61%) presented with early-stage NSTI symptoms, such as pain or erythema. Intensive care unit admission was required in 83%, with a median stay of 5 days (interquartile range 2-11). The median time from hospital admission to debridement was 8 h (interquartile range 4-23). Group A Streptococcus was cultured in 41% of patients. Extremity amputation was required in 12%, and the in-hospital mortality rate was 21%. Patients presenting with early-stage symptoms who were misdiagnosed (60%) had a significantly higher in-hospital mortality rate (30%) than those correctly diagnosed (10%; p = .003).

CONCLUSION: In the Netherlands, NSTI patient and disease characteristics vary considerably. With one in five patients dying and one in eight patients undergoing a major amputation, interventions leading to rapid diagnosis and treatment are urgently needed.