Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Sepsis Associated with Acute Necrotizing Soft Tissue Infections: The NASTI-HAT Case Series

Necrotizing soft tissue infections (NSTIs) are surgical emergencies often presenting with concomitant sepsis. The use of intravenous hydrocortisone, vitamin C (ascorbic acid), and thiamine (HAT) has been proposed as beneficial in treating sepsis. To our knowledge, no study has focused exclusively on its use in NSTIs. This study aimed to evaluate use of HAT among patients with NSTIs and included patients from a single Midwestern regional burn center. Patients diagnosed with sepsis or septic shock secondary to an NSTI were randomized and received either intravenous HAT or placebo. The primary outcome was hospital survival. Secondary outcomes included vasopressor therapy duration, renal replacement therapy need, intensive care unit length of stay, serum procalcitonin and sequential organ failure assessment (SOFA) change in the first 72 h, number of wound-related surgeries, and wound classification at hospital discharge. While our study started as a randomized controlled trial, due to low enrollment it was transitioned to a case series. Of the 10 patients enrolled, half received HAT therapy. No significant difference was found between the treatment and placebo groups. Future larger, multicenter studies may help better elucidate the role of intravenous HAT therapy in patients with NSTIs.