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Kang-Auger G, Chassé M, Quach C, Ayoub A, Auger N. Necrotizing Fasciitis: Association with Pregnancy-related Risk Factors Early in Life. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:573-584. [PMID: 34970094 PMCID: PMC8686767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Pregnancy-related risk factors for necrotizing fasciitis are poorly understood. We investigated pregnancy-related characteristics associated with the long-term risk of developing necrotizing fasciitis, a rare life-threatening infectious disease. Methods: We analyzed a longitudinal cohort of 1,344,996 parous women in Quebec, Canada between 1989 and 2020. The main exposure measures included complications of pregnancy such as gestational diabetes, preterm delivery, metabolic disorder, and other maternal characteristics. We followed the women over time to identify future hospitalizations for necrotizing fasciitis up to three decades after delivery. We estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association of pregnancy characteristics with risk of necrotizing fasciitis in time-varying Cox proportional hazards regression models. Results: A total of 420 women were hospitalized for necrotizing fasciitis during follow-up, including 83 (19.8%) with diabetes-related necrotizing fasciitis. The incidence of necrotizing fasciitis was elevated for women with gestational diabetes (2.9 per 100,000 person-years), preterm delivery (3.2 per 100,000 person-years), and metabolic disorders (5.4 per 100,000 person-years), compared with no pregnancy complication (1.1 per 100,000 person-years). Compared with no pregnancy complication, gestational diabetes was associated with 1.87 times the risk (95% CI 1.38-2.53), preterm delivery with 2.10 times the risk (95% CI 1.65-2.66), and metabolic disorder with 3.72 times the risk (95% CI 2.92-4.74) of developing necrotizing fasciitis over time. Pregnancy complications were more strongly associated with the risk of necrotizing fasciitis 5 years or more after delivery. Conclusions: Complications of pregnancy may be associated with the long-term risk of necrotizing fasciitis in women.
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Affiliation(s)
| | - Michaël Chassé
- University of Montreal Hospital Research Centre,
Montreal, Quebec, Canada,Critical Care Division, Department of Medicine,
University of Montreal, Montreal, Quebec, Canada
| | - Caroline Quach
- Department of Microbiology, Infectious Diseases, and
Immunology, University of Montreal, Montreal, Quebec, Canada,Infection Prevention and Control, Clinical Department
of Laboratory Medicine, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre,
Montreal, Quebec, Canada,Institut national de santé publique du Québec,
Montreal, Quebec, Canada
| | - Nathalie Auger
- University of Montreal Hospital Research Centre,
Montreal, Quebec, Canada,Institut national de santé publique du Québec,
Montreal, Quebec, Canada,Department of Epidemiology, Biostatistics, and
Occupational Health, McGill University, Montreal, Quebec, Canada,Department of Social and Preventive Medicine,
University of Montreal, Montreal, Quebec, Canada,To whom all correspondence should be addressed:
Dr. Nathalie Auger, 190 Cremazie Blvd E., Montreal, Quebec H2P 1E2, Canada;
; ORCID iD:
http://orcid.org/0000-0002-2412-0459
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Rumbo J, Madariaga-P I, Salazar-Reviakina A, Sierra-Breton M, Tovar C, Sequera D, Rodríguez C, Holguín J, Hurtado-Villa P, Sarmiento K, Zarante I. Association between maternal infections during pregnancy and congenital defects in their offspring: a population-based case-control study in Bogota and Cali, Colombia 2001-2018. J Matern Fetal Neonatal Med 2021; 35:8723-8727. [PMID: 34749588 DOI: 10.1080/14767058.2021.1999924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Infections are frequent during pregnancy and their teratogenic role is well documented in Toxoplasmosis, other infections, Rubella, Cytomegalovirus, and Herpes simplex (TORCH). However, the in-utero development effects of the rest of the infections that affect pregnant women are unknown. We described a cohort of patients with major Birth Defects (BD) and the exposure to infections during pregnancy from the information of Congenital Defects Surveillance Programs of two Colombian cities (Bogota and Cali) between 2001 and 2018. We evaluated associations between groups of maternal infections and BD among 3096 cases and 7446 controls that were registered. BD presentation was more frequent as isolated (64.3%), polymalformed (23.2%), and syndromic (12.4%). Infections during pregnancy were present in 52.5% of cases and 44.6% of controls. The most common single infection between cases and controls was vaginal infection. The most common polyinfection was vaginal and urinary tract infection. We found an association between BD and vaginal infections with an odds ratio (OR) 1.18 (CI 1.08-1.30), urinary tract infections OR 1.16 (CI 1.05-1.28), gastrointestinal infections OR 2.06 (IC 1.18-3.59), respiratory infections OR 1.56 (IC 1.28-1.9) and viral infections OR 1.88 (IC 1.18-3.0). Knowing the teratogenic effect of infections is important to extend prevention, screening, timely diagnosis, and appropriate treatment to pregnant women.
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Affiliation(s)
- Jose Rumbo
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | | | | | - Catherin Tovar
- Institute of Human Genetics, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Diana Sequera
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | - Jorge Holguín
- Department of Public Health and Epidemiology, Pontificia Universidad Javeriana, Cali, Colombia
| | - Paula Hurtado-Villa
- Department of Basic Sciences, Faculty of Health, Pontificia Universidad Javeriana, Cali, Colombia
| | - Karen Sarmiento
- Department of Physiological Sciences, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Ignacio Zarante
- Institute of Human Genetics, Pontificia Universidad Javeriana, Bogota, Colombia.,Genetics Service, Hospital Universitario San Ignacio, Bogota, Colombia
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Zhang JX, McSweeney CT, Bush KL. Nosocomial transmission of necrotising fasciitis organisms from prepartum patient to healthcare worker. BMJ Case Rep 2021; 14:14/5/e240848. [PMID: 34059538 DOI: 10.1136/bcr-2020-240848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Necrotising fasciitis is an aggressive skin and soft tissue infection requiring urgent surgical treatment, resuscitative efforts and intensive care management. We herein present a case of necrotising fasciitis with nosocomial transmission of causative organisms from patient to healthcare worker. Bacterial transmission from human to human despite personal protective equipment is quite rare, and with limited reports in the literature. The patient was also prepartum, representing to our knowledge, one of only a handful of cases of prepartum necrotising fasciitis. Recommendations to avoid healthcare worker transmission include wearing Association of the Advancement of Medical Instrumentation level 4 gowns during debridement, as well as eye protection and changing scrubs and showering between cases.
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Affiliation(s)
- Jacques X Zhang
- Division of Plastic Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Connor T McSweeney
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin L Bush
- Division of Plastic Surgery, The University of British Columbia, Vancouver, British Columbia, Canada
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PrabhuDas M, Piper JM, Jean-Philippe P, Lachowicz-Scroggins M. Immune Regulation, Maternal Infection, Vaccination, and Pregnancy Outcome. J Womens Health (Larchmt) 2021; 30:199-206. [PMID: 33232632 PMCID: PMC8020511 DOI: 10.1089/jwh.2020.8854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
About 12.5% of all maternal deaths in the United States are due to infectious causes. This proportion, although stable during the past three decades, represents an increase in infectious causes of mortality, as the overall mortality rate in U.S. pregnant women had increased steadily during that same period. During healthy pregnancies, a delicate immunological balance-in which a mother's immune system tolerates the semi-allogeneic fetus yet maintains immune competency against infectious agents-is achieved and maintained. This immunological paradigm, however, results in increased susceptibility to infectious diseases during pregnancy, particularly in later stages and during the early postpartum period. The inflammatory process induced by these infectious insults, as well as some noninfectious insults, occurring during pregnancy can disrupt this carefully achieved balance and, in turn, lead to a state of rampant inflammation, immune activation, and dysregulation with deleterious health outcomes for the mother and fetus. Elucidating mechanisms contributing to the disruption of this immunologic homeostasis, and its disruption by infectious pathogens, might offer opportunities for interventions to reduce maternal and fetal morbidity and mortality.
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Affiliation(s)
- Mercy PrabhuDas
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Jeanna M. Piper
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Patrick Jean-Philippe
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
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Liu TJ, Tai HC, Chien KL, Cheng NC. Predisposing factors of necrotizing fasciitis with comparison to cellulitis in Taiwan: A nationwide population-based case–control study. J Formos Med Assoc 2020; 119:18-25. [DOI: 10.1016/j.jfma.2019.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 11/29/2022] Open
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Antibiotics for the Prevention and Treatment of Postsurgical Obstetric Infections. Obstet Gynecol Surv 2019; 73:475-485. [PMID: 30169886 DOI: 10.1097/ogx.0000000000000590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nahas S, McKirdy A, Imbuldeniya A. Successful management of a 24-year-old pregnant woman with necrotising fasciitis of the forearm. BMJ Case Rep 2018; 2018:bcr-2017-222191. [PMID: 29306854 DOI: 10.1136/bcr-2017-222191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 24-year-old woman who was 24 weeks pregnant presented to the emergency department with septic shock and an elbow wound that had become infected. She sustained an injury to the tip of the right elbow on a light switch 4 days prior. In the space of 1 day, she developed a necrotising soft tissue infection, which was rapidly spread to the forearm with florid sepsis. Her initial serum C reactive protein was 392 mg/L, and white cell count was 32×109/L. The patient was treated promptly with aggressive surgical debridement and broad-spectrum antibiotics. An early multidisciplinary approach including orthopaedic surgeons, anaesthetics, intensive care, obstetrics, microbiologists and paediatrics was taken. Ultimately, both mother and child had an excellent outcome, the former of whom only had minimal soft tissue resection and primary wound closure. Emphasis is made on first treating the mother as the patient and priority.
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Affiliation(s)
- Sam Nahas
- Department of Trauma and Orthopaedics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Anne McKirdy
- Department of Trauma and Orthopaedics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Arjuna Imbuldeniya
- Department of Trauma and Orthopaedics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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