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.