Management of necrotizing soft tissue infections in the intensive care unit: results of an international survey
Nicolas de Prost1,2, Emilie Sbidian3,4,5, Olivier Chosidow3,4,5, Christian Brun-Buisson1,2, Roland Amathieu6, for the Henri Mondor Hospital Necrotizing Fasciitis Group
Online self-administered questionnaire
· 1) In which country do you practice?
· 2) In which city?
· 3) What type of institution is your hospital?
o University hospital
o Public hospital
o Private hospital
Name of your institution : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Name of your department: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
· 4) What type of ICU do you work in?
o Mixed ICU
o Medical ICU
o Surgical ICU
o Cardiac ICU
o Neurological ICU
o Burn care unit
o Other : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
· 5) What is the approximate number of patients/year admitted to your ICU?
o < 500
o 500 à 1000
o > 1000
· 6) What is the number of beds in your ICU?
· 7) What is the number of beds in your hospital?
· 8) Does your institution include
o A burn care unit?
§ Yes
§ No
o A hyperbaric oxygen therapy unit?
§ Yes
§ No
o A computed tomography?
o A magnetic resonance imaging?
· 9) In your institution, do you have access to a surgeon and an operating room 24/7?
o Yes
o No
· 10) In your institution, do you have access to a consultant dermatologist?
o Yes
o No
· 11) How many patients with confirmed necrotizing fasciitis (i.e., patients who underwent one or more surgical debridements) have you managed in your department during the past 12 months?
o 0
o 1
o 2
o 3 to 5
o More than 5
· 12) Is there, within you institution, an expert consultant whom you can specifically refer to for the surgical management of patients with NFs?
o Yes
o No
· 13) If yes, is this ?
o A plastic surgeon?
o A digestive surgeon?
o An orthopedic surgeon?
o Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
· 14) Is there, within you institution, an expert consultant whom you can specifically refer to for the medical management of patients with NFs?
o Yes
o No
· 15) If yes, is this?
o A dermatologist?
o An infectious disease specialist?
o An intensivist?
o Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
· 16) When the diagnosis of NF has been raised, do patients benefit from a priority access to the OR?
o Yes, always
o Yes, often
o Yes, sometimes
o No
· 17) From the moment when a decision of surgery has been made, the patient is usually transferred to the OR within:
o Less than 1h
o 1 to 3 h
o 3 to 6 h
o 6 to 12 h
o 12 to 24h
· 18) Is the availability of the OR a limiting step for ensuring a timely surgical management of patients with NF?
o Yes, often
o Yes, sometimes
o Yes, rarely
o No, never
· 19) After the first surgical debridement, is the first wound dressing performed in the OR (ie, « second look » approach)?
o Yes, always
o Yes, when feasible
o Yes, rarely
o No, never
· 20) When the first wound dressing is not performed in the OR, it is performed by :
o A surgeon
o An intensivist
o A dermatologist
o A nurse
o Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
· 21) Do you use vacuum-assisted wound closure during the post-operative management of patients with necrotizing fasciitis?
o Yes, always
o Yes, often
o Yes, rarely
o No, never
· 22) Have you ever referred a patient with NF to another institution?
o Yes, often
o Yes, rarely
o No, never
· 23) What is the main reason for referring a patient with NF to another institution?
o To request medical expertise
o For surgical management
o For post-operative management
o For hyperbaric oxygen therapy
o For referral to a burn care unit
o Not applicable
· 23) Do you usually decide which antibiotics to initiate based on:
o International guidelines?
o National guidelines?
o Local guidelines?
o No guidelines
· 24) Do you apply a de-escalation antibiotic strategy after the cultures of operative microbiological specimen have been made available?
o Yes, always
o Yes, often
o Yes, sometimes
o No, never
· 25) When an invasive group A streptococcal necrotizing fasciitis is suspected or documented, does your antibiotic regimen include clindamycin?
o Yes, always
o Yes, often
o Yes, rarely
o No, never
· 26) When an invasive group A streptococcal necrotizing fasciitis is suspected or documented, do you prescribe intravenous immune globulin as adjuvant therapy ?
o Yes, always
o Yes, often
o Yes, rarely
o No, never
· 27) How useful do you believe oxygen hyperbaric therapy (OHT) is in the management of necrotizing fasciitis?
o Most useful, all NF patients should receive OHT whenever possible
o Useful in specific subgroup(s) of patients (please specify which):___________
o Useful in some rare selected cases
o Not useful
· 28) Which factor do you believe is the one that impacts most on the time to surgical management of patients with NFs?
o Delayed diagnosis
o Delayed surgical decision
o Delay for getting a specialized advice
o Delayed for transferring patient to the OR (availability of the OR)
o Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
· 29) Do you believe that imaging modalities are useful decision-making tools in patients with suspected NF?
o Yes, very useful
o Yes, useful
o Yes, useful in selected cases
o Not useful
· 30) What kind of imaging technique is most often performed for your patients with suspected NFs?
o CT scan
o Echography
o MRI
o None
o Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
· 31) What microbiological specimens do you usually sample for the management of patients with NFs?
o Blood culture
o Superficial wound culture
o Surgical specimen
o Subcutaneous needle aspiration
o No specimen
o Other specimen :