Impact of Timing of Empiric Antibiotic Therapy and Surgical Intervention on Septic Shock Associated Necrotizing Fasciitis
Bibliographic record
Abstract
Abstract RATIONALE Necrotizing fasciitis is an aggressive, progressive soft tissue infection leading to septic shock, requiring immediate intervention to control infection. While delays in antibiotic therapy and surgical source control increase mortality, the benefits of very early intervention, particularly within the first 24 hours, are unclear. This study evaluated the impact of timely antibiotic and surgical interventions on patient outcomes. METHODS We used the previously published Cooperative Antimicrobial Therapy of Septic Shock (CATSS)database, which includes ICU patients in Canada, the United States, and Saudi Arabia from July1, 1989, to June 30, 2018. This study focused on adult septic shock with necrotizing fasciitis. The primary outcome was in-hospital survival. Univariate logistic regression identified factors associated with in-hospital survival, followed by survival analysis to adjust for relevant clinical variables. We included demographic variables, illness severity, delay in appropriate antibiotic treatment, and source control timing (relative to hypotension onset). RESULTS In this retrospective study, 178 cases of septic shock from necrotizing fasciitis were analyzed. Survivors had lower APACHE II scores (21.8 vs 28.8), were younger (54.2 vs 60.9), and had lower lactate levels (3.6 vs 7.2 mg/dL). Each hour of delay in appropriate antibiotics and source control increased death risk, with hazard ratios of 1.03 (95% CI: 1.02-1.04) and 1.01 (95% CI: 1.00-1.02)per hour, respectively. Diabetic patients had more than twice the death risk (Hazard Ratio: 2.39).Patients receiving antibiotics within 3 hours and source control within 6 hours had higher survival rates (83%) versus those with antibiotics delayed over 6 hours and source control delayed beyond24 hours (10%). [Figure 1] CONCLUSIONS Timely antibiotics and prompt source control improve survival in necrotizing fasciitis-related septic shock. Even slight delays increased mortality, especially when both treatments were delayed. Risk factors such as older age, higher APACHE II scores, elevated lactate, and diabetes worsened mortality. Fast, coordinated care is essential to improve outcomes in these patients. Impact of Timing of Empiric Antibiotic Therapy and Surgical Intervention on Septic Shock Associated Necrotizing Fasciitis
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".