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{
    "pk": 13399,
    "title": "Necrotizing Fasciitis Within 72 hours After Presentation with Skin and Skin Structure Infection",
    "subtitle": null,
    "abstract": "Introduction:\n A small percentage of patients with skin infections later develop necrotizing fasciitis (NF). Diagnostic testing is needed to identify patients with skin infections at low risk of NF who could be discharged from the emergency department (ED) after antibiotic initiation. Elevated lactate has been associated with NF; existing estimates of the frequency of NF are based on retrospective reviews, and cases often lack testing for lactate. We present the incidence of patients with skin infections who developed NF and their baseline lactates.\nMethods:\n In four phase-3 trials, 2883 adults with complicated or acute bacterial skin and skin structure infections were randomized to dalbavancin or comparator, with early and late follow-up visits through Day 28. We prospectively collected baseline plasma lactates in one trial to assess an association with NF.\nResults:\n NF was diagnosed in 3/2883 patients (0.1%); all three survived. In the study with prospectively collected baseline lactates (n = 622), 15/622 (2.4%) had a lactate ≥4 millimoles per liter (mmol/L), including 3/622 (0.5%) with a lactate ≥7 mmol/L. NF was not seen in patients with a lactate <4 mmol/L; NF was seen in 1/15 (6.7%) with a lactate ≥4 mmol/L, including 1/3 (33.3%) with lactate ≥7 mmol/L.\nConclusions:\n NF incidence within 72 hours of antibiotic initiation in patients with complicated or acute bacterial skin and skin structure infections was extremely low (0.1%) and occurred in 6.7% with a lactate ≥4 mmol/L. Lactate <4 mmol/L can be used to identify patients at low risk of NF who could be safely discharged from the ED after antibiotic initiation.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "necrotizing fasciitis"
        },
        {
            "word": "skin infection"
        },
        {
            "word": "lactate"
        },
        {
            "word": "Diagnosis"
        },
        {
            "word": "emergency department"
        }
    ],
    "section": "Health Outcomes",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/1v38f51n",
    "frozenauthors": [
        {
            "first_name": "Urania",
            "middle_name": "",
            "last_name": "Rappo",
            "name_suffix": "",
            "institution": "Allergan PLC, Madison, New Jersey",
            "department": "None"
        },
        {
            "first_name": "H.",
            "middle_name": "Bryant",
            "last_name": "Nguyen",
            "name_suffix": "",
            "institution": "Loma Linda University, Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine Loma Linda, California",
            "department": "None"
        },
        {
            "first_name": "Sailaja",
            "middle_name": "",
            "last_name": "Puttagunta",
            "name_suffix": "",
            "institution": "Allergan PLC, Madison, New Jersey\nBiomX Ltd, Ness Ziona, Israel",
            "department": "None"
        },
        {
            "first_name": "Caroline",
            "middle_name": "",
            "last_name": "Ojaimi",
            "name_suffix": "",
            "institution": "Allergan PLC, Madison, New Jersey\nNovartis Pharmaceuticals Corp, East Hanover, New Jersey",
            "department": "None"
        },
        {
            "first_name": "Karthik",
            "middle_name": "",
            "last_name": "Akinapelli",
            "name_suffix": "",
            "institution": "Independent consultant, Hamden, Connecticut\nIterum Therapeutics, Old Saybrook, Connecticut",
            "department": "None"
        },
        {
            "first_name": "Michael",
            "middle_name": "W.",
            "last_name": "Dunne",
            "name_suffix": "",
            "institution": "Allergan PLC, Madison, New Jersey\nIterum Therapeutics, Old Saybrook, Connecticut",
            "department": "None"
        }
    ],
    "date_submitted": "2019-12-09T03:37:27Z",
    "date_accepted": "2019-12-09T03:37:27Z",
    "date_published": "2020-07-10T19:49:47Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/13399/galley/7034/download/"
        }
    ]
}