Background: Early initiation of broad-spectrum antibiotic agents is a cornerstone of the care of necrotizing skin and soft tissue infections (NSTI). However, the optimal duration of antibiotic agents is unclear. We sought to characterize antibiotic prescribing patterns for patients with NSTI, as well as associated complications. Patients and Methods: Using an NSTI registry, we characterized antibiotic use at a quaternary referral center. Kaplan-Meier analyses were used to describe overall antibiotic duration and relative to operative source control, stratified by presence of other infections that independently influenced antibiotic duration. Factors associated with successful antibiotic discontinuation were identified using logistic regression. Results: Between 2015 and 2018, 441 patients received antibiotic agents for NSTI with 18% experiencing a complicating secondary infection. Among those without a complicating infection, the median duration of antibiotic administration was 9.8 days (95% confidence interval [CI], 9.2-10.5) overall, and 7.0 days after the final debridement. Perineal NSTI received fewer days of antibiotic agents (8.3 vs. 10.6) compared with NSTI without perineal involvement. White blood cell (WBC) count and fever were not associated with failure of antibiotic discontinuation, however, a chronic wound as the underlying infection etiology was associated with greater odds of antibiotic discontinuation failure (odds ratio [OR], 4.33; 95% CI, 1.24-15.1). Conclusions: A seven-day course of antibiotic agents after final operative debridement may be sufficient for NSTI without any secondary complicating infections, because clinical characteristics do not appear to be associated with differences in successful antibiotic discontinuation.

中文翻译：

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确定坏死性皮肤和软组织感染的最佳抗生素持续时间：来自第四级转诊中心的临床经验。

背景：早期开始使用广谱抗生素药物是坏死性皮肤和软组织感染（NSTI）护理的基石。然而，抗生素药物的最佳持续时间尚不清楚。我们试图描述 NSTI 患者的抗生素处方模式以及相关并发症。患者和方法：通过 NSTI 登记，我们对四级转诊中心的抗生素使用情况进行了描述。Kaplan-Meier 分析用于描述总体抗生素持续时间以及相对于手术源控制的情况，并根据独立影响抗生素持续时间的其他感染的存在进行分层。使用逻辑回归确定了与成功停用抗生素相关的因素。结果：2015 年至 2018 年间，441 名患者接受了 NSTI 抗生素治疗，其中 18% 出现了复杂的继发感染。在没有并发感染的患者中，抗生素给药的中位持续时间总体为 9.8 天（95% 置信区间 [CI]，9.2-10.5），最终清创后为 7.0 天。与无会阴受累的 NSTI 相比，会阴 NSTI 接受抗生素治疗的天数较少（8.3 比 10.6）。白细胞 (WBC) 计数和发烧与抗生素停药失败无关，然而，作为潜在感染病因的慢性伤口与抗生素停药失败的可能性更大相关（比值比 [OR]，4.33；95% CI， 1.24-15.1）。结论：最终手术清创后 7 天的抗生素疗程可能足以治疗 NSTI，而不会出现任何继发性并发症感染，因为临床特征似乎与成功停用抗生素的差异无关。