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Windsor C, Hua C, De Roux Q, Harrois A, Anguel N, Montravers P, Vieillard-Baron A, Mira JP, Urbina T, Gaudry S, Turpin M, Damoisel C, Annane D, Ricard JD, Hersant B, Dessap AM, Chosidow O, Layese R, de Prost N. Healthcare trajectory of critically ill patients with necrotizing soft tissue infections: a multicenter retrospective cohort study using the clinical data warehouse of Greater Paris University Hospitals. Ann Intensive Care 2022; 12:115. [PMID: 36538244 PMCID: PMC9768077 DOI: 10.1186/s13613-022-01087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Necrotizing skin and soft tissue infections (NSTIs) are rare but serious and rapidly progressive infections characterized by necrosis of subcutaneous tissue, fascia and even muscle. The care pathway of patients with NSTIs is poorly understood. A better characterization of the care trajectory of these patients and a better identification of patients at risk of a complicated evolution, requiring prolonged hospitalization, multiple surgical re-interventions, or readmission to the intensive care unit (ICU), is an essential prerequisite to improve their care. The main objective of this study is to obtain large-scale data on the care pathway of these patients. We performed a retrospective multicenter observational cohort study in 13 Great Paris area hospitals, including patients hospitalized between January 1, 2015 and December 31, 2019 in the ICU for surgically confirmed NSTIs. RESULTS 170 patients were included. The median duration of stay in ICU and hospital was 8 (3-17) and 37 (14-71) days, respectively. The median time from admission to first surgical debridement was 1 (0-2) day but 69.9% of patients were re-operated with a median of 1 (0-3) additional debridement. Inter-hospital transfer was necessary in 52.4% of patients. 80.2% of patients developed organ failures during the course of ICU stay with 51.8% of patients requiring invasive mechanical ventilation, 77.2% needing vasopressor support and 27.7% renal replacement therapy. In-ICU and in-hospital mortality rates were 21.8% and 28.8%, respectively. There was no significant difference between patients with abdomino-perineal NSTIs (n = 33) and others (n = 137) in terms of in-hospital or ICU mortality. Yet, immunocompromised patients (n = 43) showed significantly higher ICU and in-hospital mortality rates than non-immunocompromised patients (n = 127) (37.2% vs. 16.5%, p = 0.009, and 53.5% vs. 20.5%, p < 0.001). Factors associated with a complicated course were the presence of a polymicrobial infection (adjusted odds ratio [aOR = 3.18 (1.37-7.35); p = 0.007], of a bacteremia [aOR = 3.29 (1.14-9.52); p = 0.028] and a higher SAPS II score [aOR = 1.05 (1.02-1.07); p < 0.0001]. 62.3% of patients were re-hospitalized within 6 months. CONCLUSION In this retrospective multicenter study, we showed that patients with NSTI required complex management and are major consumers of care. Two-thirds of them underwent a complicated hospital course, associated with a higher SAPS II score, a polymicrobial NSTI and a bacteremia.
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Affiliation(s)
- Camille Windsor
- grid.50550.350000 0001 2175 4109Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor–Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Camille Hua
- grid.50550.350000 0001 2175 4109Service de Dermatologie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique–Hôpitaux de Paris (AP-HP), Créteil, France ,grid.410511.00000 0001 2149 7878Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Quentin De Roux
- grid.412116.10000 0004 1799 3934Département d’anesthésie-Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Anatole Harrois
- grid.413784.d0000 0001 2181 7253Département d’anesthésie-Réanimation, Université Paris Saclay, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Nadia Anguel
- grid.413784.d0000 0001 2181 7253Service de Médecine Intensive Réanimation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Philippe Montravers
- Department of Anesthesiology and Critical Care Medicine, Université Paris Cité, AP-HP, Hôpital Bichat-Claude Bernard; DMU PARABOL, Paris, France ,grid.7429.80000000121866389PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
| | - Antoine Vieillard-Baron
- grid.413756.20000 0000 9982 5352Service de Médecine Intensive Réanimation, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France ,grid.460789.40000 0004 4910 6535CESP, UMR 1018, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Jean-Paul Mira
- grid.411784.f0000 0001 0274 3893Service de Médecine Intensive Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Tomas Urbina
- grid.412370.30000 0004 1937 1100Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Stéphane Gaudry
- grid.413780.90000 0000 8715 2621Service de Médecine Intensive Réanimation, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris (AP-HP), Avicenne, Bobigny, France
| | - Matthieu Turpin
- grid.462844.80000 0001 2308 1657Service de Médecine Intensive Réanimation, Sorbonne Université, AP-HP. Hôpital Tenon, DMU APPROCHES, Paris, France
| | - Charles Damoisel
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Djillali Annane
- grid.413738.a0000 0000 9454 4367Service de Réanimation Polyvalente, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris (AP-HP), Clamart, France
| | - Jean-Damien Ricard
- grid.414205.60000 0001 0273 556XService de Médecine Intensive Réanimation, Université Paris Cité, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Colombes, France
| | - Barbara Hersant
- grid.50550.350000 0001 2175 4109Service de Chirurgie Plastique Esthétique et Reconstructrice, Hôpitaux Universitaires Henri Mondor–Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Armand Mekontso Dessap
- grid.50550.350000 0001 2175 4109Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor–Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France ,grid.410511.00000 0001 2149 7878Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France ,grid.410511.00000 0001 2149 7878Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Olivier Chosidow
- grid.50550.350000 0001 2175 4109Service de Dermatologie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique–Hôpitaux de Paris (AP-HP), Créteil, France ,grid.410511.00000 0001 2149 7878Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
| | - Richard Layese
- grid.50550.350000 0001 2175 4109Unité de Recherche Clinique, Hôpitaux Universitaires Henri Mondor–Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France ,grid.462410.50000 0004 0386 3258Equipe CEpiA (Clinical Epidemiology and Ageing), Université Paris-Est Créteil, INSERM, IMRB, Créteil, France
| | - Nicolas de Prost
- grid.50550.350000 0001 2175 4109Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor–Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France ,grid.410511.00000 0001 2149 7878Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France ,grid.410511.00000 0001 2149 7878Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France
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Urbina T, Canoui-Poitrine F, Hua C, Layese R, Alves A, Ouedraogo R, Bosc R, Sbidian E, Chosidow O, Dessap AM, de Prost N. Long-term quality of life in necrotizing soft-tissue infection survivors: a monocentric prospective cohort study. Ann Intensive Care 2021; 11:102. [PMID: 34213694 PMCID: PMC8253876 DOI: 10.1186/s13613-021-00891-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/21/2021] [Indexed: 12/21/2022] Open
Abstract
Background Compared to other life-threatening infection survivors, long-term health-related quality of life (QOL) of patients surviving necrotizing soft-tissue infections (NSTI) and its determinants are little known. In this monocentric prospective cohort including NSTI survivors admitted between 2014 and 2017, QOL was assessed during a phone interview using the 36-Item Short-Form Health Survey (SF-36), the Hospital Anxiety and Depression (HAD), the activity of daily living (ADL), instrumental ADL (IADL) scales and the Impact of Event Scale-Revised (IES-R). The primary outcome measure was the SF-36 physical component summary (PCS). NSTI patients were compared according to intensive care unit (ICU) admission status. ICU survivors were matched on SAPS II with non-NSTI related septic shock survivors. Results Forty-nine NSTI survivors were phone-interviewed and included in the study. Median PCS was decreased compared to the reference population [− 0.97 (− 2.27; − 0.08) SD]. Previous cardiac disease was the only variable associated with PCS alteration [multivariate regression coefficient: − 8.86 (− 17.64; − 0.07), p = 0.048]. Of NSTI survivors, 15.2% had a HAD-D score ≥ 5 and 61.2% an IES-R score ≥ 33. ICU admission was not associated with lower PCS [35.21 (25.49–46.54) versus (vs) 41.82 (24.12–51.01), p = 0.516], but with higher IES-R score [14 (7.5–34) vs 7 (3–18), p = 0.035] and a higher proportion of HAD-D score ≥ 5 (28.6 vs 4.0%, p = 0.036). Compared to non-NSTI septic shock-matched controls, NSTI patients had similar PCS [33.81 (24.58; − 44.39) vs 44.87 (26.71; − 56.01), p = 0.706] but higher HAD-D [3.5 (1–7) vs 3 (1.5–6), p = 0.048] and IES-R scores [18 (8–35) vs 8 (3–19), p = 0.049]. Conclusions Long-term QOL in NSTI survivors is severely impaired, similarly to that of non-NSTI septic shock patients for physical compartments, but with more frequent depressive and/or post-traumatic stress disorders. Only ICU admission and previous cardiac disease were predictive of QOL impairment. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00891-9.
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Affiliation(s)
- Tomas Urbina
- Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 75571, Paris Cedex 12, France.,Sorbonne Université, Université Pierre-Et-Marie Curie, Paris 6, France.,Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Florence Canoui-Poitrine
- Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Camille Hua
- Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Service de Dermatologie, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Richard Layese
- Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Aline Alves
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Rachida Ouedraogo
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Romain Bosc
- Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000, Créteil, France.,Henri Mondor Breast Center, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000, Créteil, France.,Biology of the NeuroMuscular System, INSERM Team U955-E10, Paris East University, 94000, Créteil, France
| | - Emilie Sbidian
- Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Service de Dermatologie, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France.,Centre D'Investigation Clinique 1430, Inserm, 94010, Créteil, France
| | - Olivier Chosidow
- Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Service de Dermatologie, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris (AP-HP), Créteil, France
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France.,Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France.,Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France
| | - Nicolas de Prost
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France. .,Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France. .,Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France.
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Chevet-Noël A, Andreoletti JB, Kheloufi M, Pluvy I. [Limb necrotizing soft tissue infection (NSTI) and necrotising fasciitis: A bicentric study between 2000 and 2017 on the quality of life and functional impact]. ANN CHIR PLAST ESTH 2019; 65:228-235. [PMID: 31186207 DOI: 10.1016/j.anplas.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/13/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Limb necrotising soft tissue infection and necrotising fasciitis surgical debridement results in significant soft tissue losses. The purpose of this study was to evaluate the functional impact and the quality of life of survivors. PATIENTS AND METHODS This bicentric retrospective study included 62 patients treated for limb necrotising soft tissue infection and necrotising fasciitis (NSTI-NF) between 2000 and 2017. Demographic, clinic, biologic and surgical data were found in Patients Medical Records. Survivors at the moment of data collection (2018) were met; their quality of life was assessed using SF-36, DLQI, BSHS-B scores and their active joints motions were measured using a goniometer. RESULTS Twenty-one patients (87.1% of the living patients at this moment) were assessed. For the joint above the injury, mean loss of flexion was 9.19% and 5% for extension whereas for the joint under the injury, mean loss of flexion was 37.65% and 48.6% for extension compared to non-injured side. Mean quality of life scores were: SF-36p: 45.88, SF-36m: 51.31, DLQI: 10.48, BSHS-B: 105.81. The statistical analysis was not able to establish a correlation between loss of motion and quality of life. CONCLUSION We have not found a relationship between loss of joints motions and long term quality of life for those patients. High excised body surface area and high length of stay are correlated with high DLQI and thus a lower quality of life.
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Affiliation(s)
- A Chevet-Noël
- Service de chirurgie orthopédique, traumatologique et plastique, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France.
| | - J B Andreoletti
- Service de chirurgie plastique, reconstructrice et esthétique, hôpital Nord Franche-Comté, 100, route de Moval, 90400 Trévenans, France
| | - M Kheloufi
- Service de surveillance post-interventionnelle, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - I Pluvy
- Service de chirurgie orthopédique, traumatologique et plastique, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
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Urbina T, Hua C, Sbidian E, Ingen-Housz-Oro S, Duong TA, Wolkenstein P, Bosc R, Razazi K, Carteaux G, Chosidow O, Mekontso Dessap A, de Prost N. Urgences dermatologiques en réanimation : infections nécrosantes de la peau et des parties molles et toxidermies graves. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les urgences dermatologiques nécessitant une admission en réanimation sont rares mais associées à une mortalité élevée et à de lourdes séquelles à long terme. Elles sont essentiellement représentées par les infections nécrosantes des tissus mous (également appelées : dermohypodermites bactériennes nécrosantes-fasciites nécrosantes [DHBN-FN]) et par les toxidermies graves que sont les nécrolyses épidermiques (comprenant le syndrome de Lyell ou nécrolyse épidermique toxique [NET], le syndrome de Stevens-Johnson [SJS] et le DRESS (drug reaction with eosinophilia and systemic symptoms)). Elles ont pour caractéristiques communes un diagnostic souvent difficile, la nécessité d’une approche multidisciplinaire et de soins paramédicaux lourds et spécifiques, imposant fréquemment le transfert dans un centre expert. Le traitement des DHBN-FN est médicochirurgical, associant un débridement chirurgical précoce et une antibiothérapie probabiliste à large spectre. La présence de signes de gravité locaux (nécrose, crépitation, douleur intense) ou généraux (sepsis, choc septique) est une indication d’urgence à l’exploration chirurgicale. Sa précocité est le principal facteur pronostique modifiable, les recommandations de thérapeutiques complémentaires (immunoglobulines intraveineuses, oxygénothérapie hyperbare, pansement à pressions négatives, ...) reposant à ce jour sur un faible niveau de preuve. L’élément essentiel de la prise en charge des toxidermies graves est la recherche et l’arrêt du médicament imputable, facteur essentiel du pronostic. Le SJS et le NET, en général associés à une ou plusieurs atteintes muqueuses, entraînent dans les formes les plus graves une défaillance cutanée aiguë. La prise en charge repose sur les soins de support (correction des troubles hydroélectrolytiques, prévention de l’hypothermie, prévention et traitement des épisodes infectieux, analgésie et anxiolyse, soins locaux). Les complications infectieuses et respiratoires sont les principales causes de décès à la phase aiguë. Aucun traitement spécifique n’a fait la preuve de son efficacité à ce jour. Le diagnostic de DRESS est difficile, et la prise en charge doit être multidisciplinaire. Sa gravité tient aux possibles atteintes viscérales associées (hépatique, rénale et cardiaque) qui justifient dans les formes graves d’une corticothérapie urgente.
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Khoshim K, Hersant B, Hotz C, SidAhmed-Mezi M, Meningaud JP. Wound healing of cutaneous substance losses based on infectious, inflammatory and traumatic skin disorders: The experience of a center. ANN CHIR PLAST ESTH 2017; 63:330-337. [PMID: 29239728 DOI: 10.1016/j.anplas.2017.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 10/30/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is no reference available concerning the standard healing time based on dermatological diseases responsible for cutaneous substance losses. The aim of our study was to assess the healing time after surgical debridement of necrotizing fasciitis (NF), hidradenitis suppurativa (HS) and skin necrosis due to trauma (SNT) based on multiples existing co-morbidities among these patients to provide surgeons with accurate scientific data in order to inform and educate patients and nurses who are practicing care under the supervision of the surgeon. MATERIALS AND METHODS This was a retrospective study. The primary endpoint was the time for complete wound healing, which was calculated from the time of the last surgical procedure to the complete wound healing corresponding to the time of complete reepithelialization, when daily dressings were no longer needed. RESULTS A total of 107 patients were included. The mean time for complete wound healing was 64.94±31.55 days in patients with NF, 45.70±21.40 days in patients with SNT and 75.02±26.41 days in patients with HS (SNT versus NF, P=0.004** and SNT versus HS, P<0.0001**). CONCLUSION The mean time for complete wound healing was 64.94 days in patients with NF, 45.70 days in patients with SNT, 75.02 days in patients with HS. This study can be considered as a referential based on the experience of a reference centre for these 3 pathologies (NF, HS, and SNT) whose aim is to inform plastic surgeons in order to anticipate the management or educate the patient.
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Affiliation(s)
- K Khoshim
- Département de chirurgie plastique et reconstructrice, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - B Hersant
- Département de chirurgie plastique et reconstructrice, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
| | - C Hotz
- Départementde dermatologie, hôpital Henri-Mondor, université Paris-Est, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - M SidAhmed-Mezi
- Département de chirurgie plastique et reconstructrice, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - J P Meningaud
- Département de chirurgie plastique et reconstructrice, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
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Meekul J, Chotirosniramit A, Himakalasa W, Orrapin S, Wongthanee A, Pongtam O, Kulprachakarn K, Rerkasem K. A Randomized Controlled Trial on the Outcome in Comparing an Alginate Silver Dressing With a Conventional Treatment of a Necrotizing Fasciitis Wound. INT J LOW EXTR WOUND 2017; 16:108-113. [PMID: 28682725 DOI: 10.1177/1534734617701051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Necrotizing fasciitis (NF) is a high morbidity and mortality disease and also demands high economic resources. The standard treatment of NF is surgical debridement and proper dressing for wound bed preparation. The efficacy of silver alginate dressing can inhibit the growth of microorganisms and keep the environment clean for wound bed preparation. However an optimal dressing to manage such wounds has yet to emerge. NF patients who were admitted between April 2013 and May 2016 were randomized to have wound dressing using either silver dressing (Ag group) or normal saline solution gauze (NSS group). The 4 main outcomes for comparison between the 2 groups were the duration of wound bed preparation, total cost during hospital stay, the duration of hospital stay, and the pain score. Thirty-nine patients were included in the study: 19 patients in the NSS group and 20 patients in the Ag group. The mean duration of wound bed preparation in the NSS group was 31.87 days, and in Ag group it was 21.39 days, but this trend was not statistically significant ( P = .057). The mean cost of treatment in the NSS and Ag groups was not significantly different ( P = .434; US$3308.83 and US$2647.82, respectively). The duration of hospital days in the 2 groups was not significantly different either (29.19 days [NSS group] and 20.99 days [Ag group]; P = .222). The pain score was significantly lower in the Ag group than those in the NSS group. Although silver dressing seems to be expensive, the cost of total treatment during hospital stay and the duration of hospital stay were not significantly different between groups. However, the mean duration of wound bed preparation seems to trend favoring toward the silver dressing group.
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Affiliation(s)
- Jarernchon Meekul
- 1 Department of Surgery, Faculty of Medicine, Chiang Mai University, Thailand
| | | | | | - Saritphat Orrapin
- 3 Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), Thailand
| | - Antika Wongthanee
- 4 NCD Center of Excellence, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Orapin Pongtam
- 5 NCD Center, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand
| | - Kanokwan Kulprachakarn
- 5 NCD Center, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand
| | - Kittipan Rerkasem
- 1 Department of Surgery, Faculty of Medicine, Chiang Mai University, Thailand.,4 NCD Center of Excellence, Research Institute of Health Sciences, Chiang Mai University, Chiang Mai, Thailand.,5 NCD Center, Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand
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