Risk Factors in Streptococcal Necrotizing Soft Tissue Infection versus Streptococcal Cellulitisa
| . | . | . | Univariate Model . | . | . | Adjusted Modelb (n = 192) . | . | . |
|---|---|---|---|---|---|---|---|---|
| NSTIc | Cellulitisc | OR | 95% CI | P value | OR | 95% CI | P value | |
| Age (years) | 42 (38–60) | 54 (43–67) | 1.008 | (.989, 1.026) | .410 | |||
| Sex (m) | 32/66 (49) | 92/146 (63) | 0.552 | (.307, .995) | .047 | 0.794 | (.344, 1.833) | .590 |
| BMI | 26 (23–30) | 28 (25–34) | 0.933d | (.886, .982) | .008 | 0.921 | (.851, .996) | .027 |
| Currently smoking | 12/61 (20) | 25/146 (17) | 1.185 | (.552, 2.545) | .663 | |||
| Excessive alcohol intakee | 7/50 (14) | 7/144 (5) | 3.186 | (1.058, 9.593) | .052 | 3.919 | (.987, 15.568) | .058 |
| Active malignancy | 3/66 (5) | 13/146 (9) | 0.487 | (.134, 1.771) | .401 | |||
| Peripheral vascular disease | 1/66 (2) | 7/146 (5) | 0.305 | (.037, 2.535) | .440 | |||
| Cardiovascular diseasef | 26/66 (39) | 60/146 (41) | 0.932 | (.515, 1.687) | .815 | |||
| Immunodeficiency/immunosuppressiong | 10/66 (15) | 12/146 (8) | 1.994 | (.815, 4.881) | .125 | |||
| Any comorbidityh | 41/66 (62) | 90/146 (62) | 1.020 | (.561, 1.857) | .947 | |||
| Blunt traumai | 11/66 (17) | 6/146 (4) | 4.667 | (1.645, 13.236) | .002 | 5.489 | (1.295, 23.269) | .016 |
| Penetrating traumai | 8/66 (12) | 20/146 (14) | 0.869 | (.362, 2.089) | .753 | |||
| Chronic wound or skin disease | 10/66 (15) | 60/146 (41) | 0.256 | (.121, .541) | <.005 | 0.377 | (.142, 1.006) | .041 |
| Intravenous drug use | 0/66 (0) | 4/144 (3) | 0.680 | (.059, 4.913) | .311 |
| . | . | . | Univariate Model . | . | . | Adjusted Modelb (n = 192) . | . | . |
|---|---|---|---|---|---|---|---|---|
| NSTIc | Cellulitisc | OR | 95% CI | P value | OR | 95% CI | P value | |
| Age (years) | 42 (38–60) | 54 (43–67) | 1.008 | (.989, 1.026) | .410 | |||
| Sex (m) | 32/66 (49) | 92/146 (63) | 0.552 | (.307, .995) | .047 | 0.794 | (.344, 1.833) | .590 |
| BMI | 26 (23–30) | 28 (25–34) | 0.933d | (.886, .982) | .008 | 0.921 | (.851, .996) | .027 |
| Currently smoking | 12/61 (20) | 25/146 (17) | 1.185 | (.552, 2.545) | .663 | |||
| Excessive alcohol intakee | 7/50 (14) | 7/144 (5) | 3.186 | (1.058, 9.593) | .052 | 3.919 | (.987, 15.568) | .058 |
| Active malignancy | 3/66 (5) | 13/146 (9) | 0.487 | (.134, 1.771) | .401 | |||
| Peripheral vascular disease | 1/66 (2) | 7/146 (5) | 0.305 | (.037, 2.535) | .440 | |||
| Cardiovascular diseasef | 26/66 (39) | 60/146 (41) | 0.932 | (.515, 1.687) | .815 | |||
| Immunodeficiency/immunosuppressiong | 10/66 (15) | 12/146 (8) | 1.994 | (.815, 4.881) | .125 | |||
| Any comorbidityh | 41/66 (62) | 90/146 (62) | 1.020 | (.561, 1.857) | .947 | |||
| Blunt traumai | 11/66 (17) | 6/146 (4) | 4.667 | (1.645, 13.236) | .002 | 5.489 | (1.295, 23.269) | .016 |
| Penetrating traumai | 8/66 (12) | 20/146 (14) | 0.869 | (.362, 2.089) | .753 | |||
| Chronic wound or skin disease | 10/66 (15) | 60/146 (41) | 0.256 | (.121, .541) | <.005 | 0.377 | (.142, 1.006) | .041 |
| Intravenous drug use | 0/66 (0) | 4/144 (3) | 0.680 | (.059, 4.913) | .311 |
Boldface indicates statistical significance (P < .05).
Abbreviations: BMI, body mass index; CI, confidence interval; NSTI, necrotizing soft tissue infection; OR, odds ratio.
aNSTI caused by Streptococcus pyogenes or Streptococcus dysgalactiae vs cellulitis with these microbes confirmed by serology (anti-streptolysin O or anti-DNAse B) or culture in blood or normally sterile tissue. See ref. [17] for criteria. To analyze an NSTI population comparable with the cellulitis cohort, the following NSTI cases were excluded: polymicrobial cases with gram-negative or anaerobic bacteria, postoperative cases (cases with surgery the previous 4 weeks), and cases from Denmark (due to a substantially higher background level of alcohol consumption).
bFactors with a P value below .10 in the univariate analyses (performed also for chronic liver disease and diabetes mellitus) were included in the multivariable model. Adjustment for infection site was performed. A total of 49 NSTI patients and 143 cellulitis controls were included in the adjusted analysis.
cData are presented as median (interquartile range) or no./No. evaluated. (%).
dData were missing for 1 NSTI and 1 cellulitis patient.
eDefined as >14 units/week of alcohol for women and >21/week for men.
fIncludes hypertension and peripheral vascular disease.
gInnate immunodeficiencies, human immunodeficiency virus, use of steroids or other immunosuppressant drugs, other acquired immunodeficiencies.
hNone of the following: active malignancy, chronic obstructive pulmonary disease or asthma, current or previous cardiovascular disease, diabetes mellitus, chronic kidney failure, chronic liver disease, rheumatoid disease, immunodeficiency/ immunosuppression.
iIn a period of 4 weeks before diagnosis.
Risk Factors in Streptococcal Necrotizing Soft Tissue Infection versus Streptococcal Cellulitisa
| . | . | . | Univariate Model . | . | . | Adjusted Modelb (n = 192) . | . | . |
|---|---|---|---|---|---|---|---|---|
| NSTIc | Cellulitisc | OR | 95% CI | P value | OR | 95% CI | P value | |
| Age (years) | 42 (38–60) | 54 (43–67) | 1.008 | (.989, 1.026) | .410 | |||
| Sex (m) | 32/66 (49) | 92/146 (63) | 0.552 | (.307, .995) | .047 | 0.794 | (.344, 1.833) | .590 |
| BMI | 26 (23–30) | 28 (25–34) | 0.933d | (.886, .982) | .008 | 0.921 | (.851, .996) | .027 |
| Currently smoking | 12/61 (20) | 25/146 (17) | 1.185 | (.552, 2.545) | .663 | |||
| Excessive alcohol intakee | 7/50 (14) | 7/144 (5) | 3.186 | (1.058, 9.593) | .052 | 3.919 | (.987, 15.568) | .058 |
| Active malignancy | 3/66 (5) | 13/146 (9) | 0.487 | (.134, 1.771) | .401 | |||
| Peripheral vascular disease | 1/66 (2) | 7/146 (5) | 0.305 | (.037, 2.535) | .440 | |||
| Cardiovascular diseasef | 26/66 (39) | 60/146 (41) | 0.932 | (.515, 1.687) | .815 | |||
| Immunodeficiency/immunosuppressiong | 10/66 (15) | 12/146 (8) | 1.994 | (.815, 4.881) | .125 | |||
| Any comorbidityh | 41/66 (62) | 90/146 (62) | 1.020 | (.561, 1.857) | .947 | |||
| Blunt traumai | 11/66 (17) | 6/146 (4) | 4.667 | (1.645, 13.236) | .002 | 5.489 | (1.295, 23.269) | .016 |
| Penetrating traumai | 8/66 (12) | 20/146 (14) | 0.869 | (.362, 2.089) | .753 | |||
| Chronic wound or skin disease | 10/66 (15) | 60/146 (41) | 0.256 | (.121, .541) | <.005 | 0.377 | (.142, 1.006) | .041 |
| Intravenous drug use | 0/66 (0) | 4/144 (3) | 0.680 | (.059, 4.913) | .311 |
| . | . | . | Univariate Model . | . | . | Adjusted Modelb (n = 192) . | . | . |
|---|---|---|---|---|---|---|---|---|
| NSTIc | Cellulitisc | OR | 95% CI | P value | OR | 95% CI | P value | |
| Age (years) | 42 (38–60) | 54 (43–67) | 1.008 | (.989, 1.026) | .410 | |||
| Sex (m) | 32/66 (49) | 92/146 (63) | 0.552 | (.307, .995) | .047 | 0.794 | (.344, 1.833) | .590 |
| BMI | 26 (23–30) | 28 (25–34) | 0.933d | (.886, .982) | .008 | 0.921 | (.851, .996) | .027 |
| Currently smoking | 12/61 (20) | 25/146 (17) | 1.185 | (.552, 2.545) | .663 | |||
| Excessive alcohol intakee | 7/50 (14) | 7/144 (5) | 3.186 | (1.058, 9.593) | .052 | 3.919 | (.987, 15.568) | .058 |
| Active malignancy | 3/66 (5) | 13/146 (9) | 0.487 | (.134, 1.771) | .401 | |||
| Peripheral vascular disease | 1/66 (2) | 7/146 (5) | 0.305 | (.037, 2.535) | .440 | |||
| Cardiovascular diseasef | 26/66 (39) | 60/146 (41) | 0.932 | (.515, 1.687) | .815 | |||
| Immunodeficiency/immunosuppressiong | 10/66 (15) | 12/146 (8) | 1.994 | (.815, 4.881) | .125 | |||
| Any comorbidityh | 41/66 (62) | 90/146 (62) | 1.020 | (.561, 1.857) | .947 | |||
| Blunt traumai | 11/66 (17) | 6/146 (4) | 4.667 | (1.645, 13.236) | .002 | 5.489 | (1.295, 23.269) | .016 |
| Penetrating traumai | 8/66 (12) | 20/146 (14) | 0.869 | (.362, 2.089) | .753 | |||
| Chronic wound or skin disease | 10/66 (15) | 60/146 (41) | 0.256 | (.121, .541) | <.005 | 0.377 | (.142, 1.006) | .041 |
| Intravenous drug use | 0/66 (0) | 4/144 (3) | 0.680 | (.059, 4.913) | .311 |
Boldface indicates statistical significance (P < .05).
Abbreviations: BMI, body mass index; CI, confidence interval; NSTI, necrotizing soft tissue infection; OR, odds ratio.
aNSTI caused by Streptococcus pyogenes or Streptococcus dysgalactiae vs cellulitis with these microbes confirmed by serology (anti-streptolysin O or anti-DNAse B) or culture in blood or normally sterile tissue. See ref. [17] for criteria. To analyze an NSTI population comparable with the cellulitis cohort, the following NSTI cases were excluded: polymicrobial cases with gram-negative or anaerobic bacteria, postoperative cases (cases with surgery the previous 4 weeks), and cases from Denmark (due to a substantially higher background level of alcohol consumption).
bFactors with a P value below .10 in the univariate analyses (performed also for chronic liver disease and diabetes mellitus) were included in the multivariable model. Adjustment for infection site was performed. A total of 49 NSTI patients and 143 cellulitis controls were included in the adjusted analysis.
cData are presented as median (interquartile range) or no./No. evaluated. (%).
dData were missing for 1 NSTI and 1 cellulitis patient.
eDefined as >14 units/week of alcohol for women and >21/week for men.
fIncludes hypertension and peripheral vascular disease.
gInnate immunodeficiencies, human immunodeficiency virus, use of steroids or other immunosuppressant drugs, other acquired immunodeficiencies.
hNone of the following: active malignancy, chronic obstructive pulmonary disease or asthma, current or previous cardiovascular disease, diabetes mellitus, chronic kidney failure, chronic liver disease, rheumatoid disease, immunodeficiency/ immunosuppression.
iIn a period of 4 weeks before diagnosis.
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