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Characteristics, Therapies, and Outcome of Children With Necrotizing Soft Tissue Infections

Endorf, Frederick W. MD*; Garrison, Michelle M. PhD; Klein, Matthew B. MD‡,§; Richardson, Andrea MS; Rivara, Frederick P. MD, MPH‡,§,‖

The Pediatric Infectious Disease Journal: March 2012 - Volume 31 - Issue 3 - p 221–223
doi: 10.1097/INF.0b013e3182456f02
Original Studies

Objectives: Necrotizing soft tissue infections (NSTIs) are uncommon but potentially lethal infections that are well described in adults. Little is known about pediatric patients with NSTI. We sought to examine patients' characteristics, infection characteristics, treatment patterns, and outcomes of children with NSTIs using a large multicenter pediatric database.

Study Design: The Pediatric Health Information System database was used to examine demographics, diagnoses, procedures, medications, hospital charges, and outcomes of pediatric patients with NSTI during a 5-year period.

Results: A total of 334 patients with NSTI were identified. Times from admission to initial amputations and reconstructive surgeries were similar between the 2 groups, but nonsurvivors had a longer time from admission to their first debridement (median, 2 vs. 1 day, P = 0.03). On multivariate analysis, no other significant risk factors for increased mortality were identified, although increased age (P = 0.10), noncommercial insurance (P = 0.12), and use of corticosteroid therapy (P = 0.06) showed trends toward increased mortality. Diagnoses of streptococcal (P = 0.03) or staphylococcal infection (P = 0.03) were associated with a lower mortality on multivariate analysis.

Conclusions: NSTIs are a rare but significant diseases in children. It seems that, as in the adult population, prompt surgical debridement is the most important intervention. Corticosteroid therapy may be associated with a worse prognosis.

From the *Department of Surgery, Regions Hospital, St. Paul, MN; †Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA; ‡Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC; §Carolina Population Center, Chapel Hill, NC; ¶Harborview Medical Center, Seattle, WA; and ‖Harborview Injury Prevention Research Center, Seattle, WA.

Accepted for publication October 16, 2011.

F.W.E. wrote the first draft of the manuscript, and received no payment for writing the manuscript.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Frederick W. Endorf, MD, The Burn Center, Regions Hospital, 640 Jackson St, St. Paul, MN 55101. E-mail:

© 2012 by Lippincott Williams & Wilkins, Inc.