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2017 ; 29
(2
): 195-205
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Infecções da pele e de tecidos moles na unidade de terapia intensiva: estudo
retrospectivo em um centro terciário
#MMPMID28614442
Malheiro LF
; Magano R
; Ferreira A
; Sarmento A
; Santos L
Rev Bras Ter Intensiva
2017[Apr]; 29
(2
): 195-205
PMID28614442
show ga
OBJECTIVE: To identify factors that may influence outcomes in patients with
severe skin and soft tissue infections in the intensive care unit. METHODS: A
retrospective observational study was conducted in a cohort of 1,123 critically
ill patients admitted to an intensive care unit with a primary or secondary
diagnosis of severe skin and soft tissues infection between January 2006 and
December 2014. RESULTS: Thirty patients were included, 20 (66.7%) of whom were
diagnosed with necrotizing fasciitis; in these patients, perineal area
involvement was most commonly identified. Abscess was diagnosed in 8 (26.7%)
patients, most commonly involving the cervical area. Risk factors such as
immunosuppression and previous surgical trauma were commonly observed in this
population. The most commonly isolated microorganism was Escherichia coli.
Multidrug resistant microorganisms were commonly detected, even in the absence of
traditional risk factors; among these patients, previous use of antibiotics was
the most common risk factor for drug resistance. The rate of mortality was
significantly higher in patients with necrotizing fasciitis (55%, p = 0.035) and
associated with disease severity, presence of septic shock, cardiac arrest and
leucocytosis. CONCLUSION: Different risk factors and etiologies of severe skin
and soft tissue infections were identified. Necrotizing fasciitis and
drug-resistant bacteria were significant predictors of mortality, even in the
absence of traditional risk factors. Obtaining a better understanding of trends
in the risk factors and microorganisms associated with severe skin infections may
help in the determination of prompt treatment and antibiotic choices.