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Al Nour AH, Kothe S. [Fatal retroperitoneal necrotizing fasciitis due to Aeromonas caviae septicaemia]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:952-954. [PMID: 38700743 DOI: 10.1007/s00108-024-01716-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 08/30/2024]
Abstract
Aeromonas is well-recognized for causing diarrhea and post-traumatic wound infections. The most common Aeromonas species include Aeromonas hydrophila, Aeromonas caviae, and Aeromonas sobria. In cases of immunocompromise and malignancy, Aeromonas infections can prove fatal. Instances of deadly necrotizing fasciitis in the extremities due to Aeromonas infection have been documented. Herein, a case of previously unreported fatal retroperitoneal necrotizing fasciitis involving Aeromonas caviae in a patient with a history of gastric cancer is presented.
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Affiliation(s)
- Al Hossain Al Nour
- Department of internal medicine, Städtisches Klinikum Dessau, Marienstr. 10, 06844, Dessau (Roßlau), Deutschland.
| | - Stefan Kothe
- Department of Surgery, Helios Klinik Lutherstadt Eisleben, Lutherstadt Eisleben, Deutschland
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2
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Illg C, Denzinger M, Rachunek K, Farzaliyev F, Thiel JT, Daigeler A, Krauss S. Is overweight a predictor for a more severe course of disease in cases of necrotizing fasciitis? Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02638-0. [PMID: 39190067 DOI: 10.1007/s00068-024-02638-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 08/04/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE Necrotizing fasciitis is a rare but severe soft tissue infection, and its diagnosis is difficult and often delayed. Immediate treatment comprising extensive debridement, highly dosed broad-spectrum antibiotic therapy and intensive care is necessary to prevent fatal outcomes. Considering the global rise in overweight patients and the known negative effects of obesity on the immune system, the aim of this study was to analyze whether overweight results in a more severe course of necrotizing fasciitis, worse outcomes and an increased mortality rate among overweight patients compared than in normal weight patients. METHODS The present study involved a retrospective analysis of 29 patients who were treated for necrotizing fasciitis in our level one trauma center during the eight-year period between 2013 and 2020. Based on their BMIs, the patients were assigned to either the overweight group (BMI > 25) or the normal weight group. RESULTS In the study population, being overweight appeared to be a predictor for a more severe course of necrotizing fasciitis. Overweight patients suffered from sepsis significantly more often than normal weight patients (13 vs. 5; p = 0.027). Furthermore, they were dependent on invasive ventilation (26.6 ± 33.8 vs. 5.9 ± 11.9 days; p = 0.046) as well as catecholamine support (18.4 ± 23.7 vs. 3.6 ± 5.7 days; p = 0.039) for significantly longer. CONCLUSION Necrotizing fasciitis remains a challenging and potentially fatal disease. Within the patient collective, the severity of the disease and treatment effort were increased among overweight patients.
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Affiliation(s)
- Claudius Illg
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany.
| | - Markus Denzinger
- Department of Pediatric Surgery, University Medical Center, Regensburg, Germany
| | - Katarzyna Rachunek
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany
| | - Farhad Farzaliyev
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany
| | - Johannes T Thiel
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany
| | - Sabrina Krauss
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany
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Sloane S, Subramony R, Olandt CA, Campbell C. Rapidly Progressive Myonecrosis Diagnosed by Point-of-Care Ultrasound. J Emerg Med 2024; 66:e728-e731. [PMID: 38782661 DOI: 10.1016/j.jemermed.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/06/2023] [Accepted: 02/02/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Skyler Sloane
- University of California San Diego, San Diego, California
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Maher E, Anokhin A. Bacterial Skin and Soft Tissue Infections in Older Adults. Clin Geriatr Med 2024; 40:117-130. [PMID: 38000856 DOI: 10.1016/j.cger.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
This article focuses on bacterial infections that commonly affect geriatric patients. The elderly population is at a higher risk of contracting bacterial infections due to weakened immune systems and comorbidities. The article explores the cause, pathogenesis, clinical manifestations, and treatment options of these infections. Additionally, antibiotic resistance is a growing concern in the treatment of bacterial infections. The article highlights the importance of preventing these infections through proper hygiene and wound care. This article aims to provide an understanding of bacterial infections in geriatric patients and inform health-care providers on the most effective ways to manage and prevent these infections.
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Affiliation(s)
- Eamonn Maher
- Department of Dermatology, University of Minnesota, Phillips-Wangensteen Building, 516 Delaware Street SE, Suite 1-400, Minneapolis, MN 55455, USA.
| | - Anya Anokhin
- University of Missouri, Phillips-Wangensteen Building, 516 Delaware Street SE, Suite 1-400, Minneapolis, MN 55455, USA
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Anshu DA, Dwivedi DS, Murali DM, MP DH. Necrotising Soft Tissue Infection in Present Era: A Clinicopathological Analysis & Predictors of Mortality. SURGERY IN PRACTICE AND SCIENCE 2023. [DOI: 10.1016/j.sipas.2023.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Shah S, Budania P, Shah A, Parmar U. Unique way of chest wall reconstruction using Integra Dermal Regeneration Template (IDRT) in a patient with post traumatic mucormycosis: A case report. Int J Surg Case Rep 2022; 95:107229. [PMID: 35617736 PMCID: PMC9133762 DOI: 10.1016/j.ijscr.2022.107229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Necrotizing soft tissue infections (NSTI) are caused by toxin-producing bacteria and fungi that results in rapid progression of disease with significant local tissue destruction. CASE PRESENTATION We present a case report of a 57-year-old male patient in line with the SCARE 2020 criteria. He was admitted to the emergency department with a small abrasion on the right antero-lateral chest wall, and a diffuse necrotic patch of skin and soft tissues with purulent discharge. CLINICAL DISCUSSION Clinical examination, routine blood investigations, CT scan chest, and chest x-ray were performed. Patient underwent debridement six times, followed by negative pressure wound therapy (NPWT). After negative culture report, Integra Meshed Dermal Regeneration Template (IMDRT), measuring 4 × 5 in. was applied and NPWT continued. The outer layer of IDRT was removed on Day 19. Split thickness skin grafting (STSG) was performed once neodermis formation was confirmed. NPWT was continued post skin grafting for a week. IDRT was successfully taken up over the raw area with exposed lung. Patient was discharged 10 days after STSG. The patient's condition improved remarkably and he was able to breathe normally. There was no puckering or tethering effect on the grafted area and not much fibrosis. He showed speedy recovery with healed donor site and 100% uptake of grafted tissue. CONCLUSION IDRT along with NPWT is an effective and useful technique for spontaneous regeneration of the dermis and basement membrane to promote wound healing in traumatic patients with NSTIs. LEVEL OF EVIDENCE Level V. STUDY TYPE Therapeutic.
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Affiliation(s)
- Sanjay Shah
- Consultant Trauma Surgeon and Head, Emergency Department, Apollo Hospitals International Ltd, Gandhinagar, Gujarat, India.
| | - Pushpa Budania
- Dept of General Surgery, Apollo Hospitals Int Ltd, Gandhinagar, Gujarat, India
| | - Akshay Shah
- Dept of General Surgery, Apollo Hospitals Int Ltd, Gandhinagar, Gujarat, India
| | - Uvaish Parmar
- Dept of General Surgery, Apollo Hospitals Int Ltd, Gandhinagar, Gujarat, India
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Autologous Cell Harvesting System as Adjunct for Soft-tissue Reconstruction of Necrotizing Soft Tissue Infection. Plast Reconstr Surg Glob Open 2022; 10:e4197. [PMID: 35317465 PMCID: PMC8932480 DOI: 10.1097/gox.0000000000004197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/25/2022] [Indexed: 11/26/2022]
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Hechter S, Patel V, Bommu VJL, Patel P, Ao X, Alnabwani D, Cheriyath P. Necrotizing Fasciitis: A Life-Threatening Infection Due to Clostridium Species. Cureus 2022; 14:e22315. [PMID: 35350517 PMCID: PMC8933863 DOI: 10.7759/cureus.22315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/05/2022] Open
Abstract
Necrotizing fasciitis (NF), soft tissue infections, are rare but rapidly progressive and life-threatening infections with high morbidity and mortality rates. Early detection and intervention by physicians are paramount in mortality prevention. We present a case report of a 77-year-old female who presented with extensive NF due to a Clostridium septicum infection.
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Shaffer PT, Hook J, Potter B. A Rare Case of Monomicrobial Necrotizing Fasciitis Associated With an Initial Acute Compartment Syndrome. J Foot Ankle Surg 2022; 61:195-198. [PMID: 34493432 DOI: 10.1053/j.jfas.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/22/2021] [Accepted: 08/11/2021] [Indexed: 02/03/2023]
Abstract
In this article we report a rare case of necrotizing fasciitis presenting with the possible initial symptom of compartment syndrome. After treatment with broad spectrum and targeted antibiotics in addition to multiple fasciotomies, surgical debridement, and grafts the patient went on to uneventful healing within 6 months. This case report highlights the possibility of a compartment syndrome as the only initial symptom of a monomicrobial necrotizing soft tissue infection. While multiple case reports have documented group A streptococcal cellulitis as initiating a later acute compartment syndrome, this is to our knowledge the first case in the foot and ankle of compartment syndrome as a possible early symptom of a group A streptococcal (monomicrobial) necrotizing fasciitis.
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Affiliation(s)
- P Tanner Shaffer
- Resident Physician PGY2, Mercy Hospital & Medical Center, Chicago, IL.
| | - Jonathan Hook
- Assistant Residency Director at Mercy Hospital & Medical Center, Associate at Midland Orthopedics, Chicago, IL
| | - Benjamin Potter
- Benjamin Potter DPM, Resident Physician PGY3, Mercy Hospital & Medical Center, Chicago, IL
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In silico, in vitro and in vivo analysis of putative virulence factors identified in large clostridial toxin-negative, binary toxin- producing C. difficile strains. Anaerobe 2019; 60:102083. [PMID: 31377188 DOI: 10.1016/j.anaerobe.2019.102083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/28/2019] [Accepted: 07/31/2019] [Indexed: 01/05/2023]
Abstract
The relevance of large clostridial toxin-negative, binary toxin-producing (A-B-CDT+) Clostridium difficile strains in human infection is still controversial. In this study, we investigated putative virulence traits that may contribute to the role of A-B-CDT+C. difficile strains in idiopathic diarrhea. Phenotypic assays were conducted on 148 strains of C. difficile comprising 10 different A-B-CDT+C. difficile ribotypes (RTs): 033, 238, 239, 288, 585, 586, QX143, QX444, QX521 and QX629. A subset of these isolates (n = 53) was whole-genome sequenced to identify genetic loci associated with virulence and survival. Motility studies showed that with the exception of RT 239 all RTs tested were non-motile. C. difficile RTs 033 and 288 had deletions in the F2 and F3 regions of their flagella operon while the F2 region was absent from strains of RTs 238, 585, 586, QX143, QX444, QX521 and QX629. The flagellin and flagella cap genes, fliC and fliD, respectively, involved in adherence and host colonization, were conserved in all strains, including reference strains. All A-B-CDT+C. difficile strains produced at least three extracellular enzymes (deoxyribonuclease, esterase and mucinase) indicating that these are important extracellular proteins. The toxicity of A-B-CDT+C. difficile strains in Vero cells was confirmed, however, pathogenicity was not demonstrated in a mouse model of disease. Despite successful colonization by most strains, there was no evidence of disease in mice. This study provides the first in-depth analysis of A-B-CDT+C. difficile strains and contributes to the current limited knowledge of these strains as a cause of C. difficile infection.
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11
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Kumar D, Cortés-Penfield NW, El-Haddad H, Musher DM. Bowel Perforation Resulting in Necrotizing Soft-Tissue Infection of the Abdomen, Flank, and Lower Extremities. Surg Infect (Larchmt) 2018; 19:467-472. [PMID: 29893614 DOI: 10.1089/sur.2018.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Fournier's gangrene is a necrotizing soft-tissue infection (NSTI) that often originates from a break in bowel integrity and affects the perineum, anus, or genitalia. Although the pathogenesis is similar, NSTI caused by a break in bowel integrity less commonly presents as infection of other sites. OBJECTIVE To characterize NSTIs originating from bowel perforation and presenting as infection of the abdominal wall, flank, or thigh but that largely spare the perineum, anus, and genitalia. METHODS We describe a characteristic case and summarize findings from 67 reported cases. RESULTS The causes of bowel injury included trauma (29%), perforated appendicitis (23%), perforated diverticulitis (16%), and perforation of a gastrointestinal tract cancer (16%). The symptomatic prodrome is indolent and nondescript. Most patients have polymicrobial infections and require antibiotic therapy combined with serial surgical debridements. Because the presentation differs from that of typical Fournier's gangrene, recognition of NSTI was delayed in the reported cases, and the associated bowel perforation often was overlooked, leading to delayed surgical treatment. As a result, the mortality rate was >33%, far exceeding that of typical Fournier's gangrene. Delays in diagnosis or surgical intervention predict a poor outcome. CONCLUSIONS An NSTI resulting from bowel perforation can present in an atypical fashion carrying significant morbidity and mortality rates. Delayed diagnosis and treatment of this condition is associated with a poor outcome.
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Affiliation(s)
- Disha Kumar
- 1 School of Medicine, Baylor College of Medicine , Houston, Texas
| | - Nicolás W Cortés-Penfield
- 2 Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine , Houston, Texas
| | - Hanine El-Haddad
- 2 Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine , Houston, Texas.,3 Division of Infectious Diseases, University of Kentucky College of Medicine , Lexington, Kentucky
| | - Daniel M Musher
- 2 Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine , Houston, Texas.,4 Medical Care Line, Section of Infectious Diseases, Micheal E. DeBakey Veterans Affairs Medical Center , Houston, Texas
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12
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Spiridakis KG, Intzepogazoglou DS, Flamourakis ME, Sfakianakis EE, Daskalaki AV, Vakonaki EK, Rahmanis E, Kostakis GE, Christodoulakis MS. Necrotizing fasciitis associated with primary cutaneous B-cell lymphoma. A case report. G Chir 2017; 38:130-134. [PMID: 29205142 DOI: 10.11138/gchir/2017.38.3.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Necrotizing fasciitis is a rapidly progressive and life-threatening infection of the deeper skin layers and subcutaneous tissues that moves along the facial planes. OBJECTIVES We present the rare case of a patient with necrotizing fasciitis associated with high malignancy b-cell lymphoma. Our purpose is to investigate the probable connection between the two pathologies and evaluate the importance of early surgical intervention. CASE REPORT 51-year old Caucasian woman presented at the E.R. with history of a painful left thigh over a week and fever up to 38,4°C over the last three days. Necrosis of the soft tissues and fascial planes were observed clinically. After the initial treatment and due to the patient's multiple organ dysfunction (septic shock), she was transferred to the ICU were she was intubated resuscitated with IV fluids and given IV antibiotics. 24 hours after the admission it was decided that the patient should undergo surgery and an extensive debridement of the necrotic area was performed. The antibiogram of the blood culture revealed streptococcus pyogenes and she was administered penicillin while intubated and monitored in the ICU until the seventh postoperative day. On the eighth post-day she was transferred back to the surgical department, hemodynamically normal and stable. She was discharged one month later and she was referred to a plastic surgery center for the final reconstruction surgery. CONCLUSIONS This case highlights that the high index of suspicion and the early aggressive surgical intervention seems to be very critical to improve survival of the patients with necrotizing fasciitis.
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Marchesi A, Marcelli S, Parodi PC, Perrotta RE, Riccio M, Vaienti L. Necrotizing Fasciitis in Aesthetic Surgery: A Review of the Literature. Aesthetic Plast Surg 2017; 41:352-358. [PMID: 28062962 DOI: 10.1007/s00266-016-0754-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/25/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Necrotizing fasciitis (NF) is a rare, potentially fatal, infective complication that can occur after surgery. Diagnosis is still difficult and mainly based on clinical data. Only a prompt pharmacological and surgical therapy can avoid dramatic consequences. There are few reports regarding NF as a complication after aesthetic surgical procedures, and a systematic review still lacks. MATERIALS AND METHODS We have performed a systematic review of English literature on PubMed, covering a period of 30 years. Keywords used were "necrotising fasciitis" matched with "aesthetic surgery complications", "breast surgery", "mammoplasty", "blepharoplasty", "liposuction", "facelift", "rhinoplasty fasciitis", "arm lift", "thigh lift", "otoplasty" and "abdominoplasty fasciitis". No additional search and temporal limitation were set. RESULTS Among 3782 papers concerning NF, only 18 were related to NF after an aesthetic surgical procedure. Liposuction was the most affected procedure, with buttocks and lower extremity the most involved anatomical regions. The majority of the infections were monomicrobial, promoted by Streptococcus pyogenes. In most cases, NF occurred within the third post-operative day with non-specific signs and symptoms. In 14 cases, a single or multiple surgical interventions were performed and survival was achieved in 11 patients. CONCLUSIONS In case of infection after aesthetic surgery, we should always bear in mind NF. Clinical hallmarks still guide NF management. Because early signs and symptoms are usually non-specific, a strict clinical control is highly suggested. Once clinical suspicion is raised, prompt antibacterial therapy should be administered, followed by surgical debridement in case of ineffective response. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Andrea Marchesi
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy.
| | - Stefano Marcelli
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy
| | - Pier C Parodi
- Department of Plastic and Reconstructive Surgery, University of Udine, Udine, Italy
| | - Rosario E Perrotta
- Department of Medical and Surgery Specialties, Section of Plastic Surgery, University of Catania, Catania, Italy
| | - Michele Riccio
- Department of Reconstructive Plastic Surgery-Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
| | - Luca Vaienti
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy
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Lesaffer J, Van Holder C, Haeck L. Necrotizing Fasciitis of the First Ray Caused by Group a Streptococcus. ACTA ACUST UNITED AC 2016; 31:317-9. [PMID: 16530304 DOI: 10.1016/j.jhsb.2006.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Revised: 01/09/2006] [Accepted: 01/20/2006] [Indexed: 11/29/2022]
Abstract
Necrotizing fasciitis of the hand is a rare clinical entity, frequently with devastating functional consequences. A case of necrotizing fasciitis of the thumb and thenar eminence caused by Group A Streptococcus is reported and the management of this condition in the upper limb discussed.
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Affiliation(s)
- J Lesaffer
- Department of General Surgery, OLV van Lourdes Hospital, Waregem, Belgium.
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Jabbour G, El-Menyar A, Peralta R, Shaikh N, Abdelrahman H, Mudali IN, Ellabib M, Al-Thani H. Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital. World J Emerg Surg 2016; 11:40. [PMID: 27508002 PMCID: PMC4977757 DOI: 10.1186/s13017-016-0097-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/02/2016] [Indexed: 12/18/2022] Open
Abstract
Background Necrotizing fasciitis (NF) is a fatal aggressive infectious disease. We aimed to assess the major contributing factors of mortality in NF patients. Methods A retrospective study was conducted at a single surgical intensive care unit between 2000 and 2013. Patients were categorized into 2 groups based on their in-hospital outcome (survivors versus non-survivors). Results During a14-year period, 331 NF patients were admitted with a mean age of 50.8 ± 15.4 years and 74 % of them were males Non-survivors (26 %) were 14.5 years older (p = 0.001) and had lower frequency of pain (p = 0.01) and fever (p = 0.001) than survivors (74 %) at hospital presentation. Diabetes mellitus, hypertension, and coronary artery disease were more prevalent among non-survivors (p = 0.001). The 2 groups were comparable for the site of infection; except for sacral region that was more involved in non-survivors (p = 0.005). On admission, non-survivors had lower hemoglobin levels (p = 0.001), platelet count (p = 0.02), blood glucose levels (p = 0.07) and had higher serum creatinine (p = 0.001). Non-survivors had greater median LRINEC (Laboratory Risk Indicator for NECrotizing fasciitis score) and Sequential Organ Failure Assessment (SOFA) scores (p = 0.001). Polybacterial and monobacterial gram negative infections were more evident in non-survivors group. Monobacterial pseudomonas (p = 0.01) and proteus infections (p = 0.005) were reported more among non-survivors. The overall mortality was 26 % and the major causes of death were bacteremia, septic shock and multiorgan failure. Multivariate analysis showed that age and SOFA score were independent predictors of mortality in the entire study population. Conclusion The mortality rate is quite high as one quarter of NF patients died during hospitalization. The present study highlights the clinical and laboratory characteristics and predictors of mortality in NF patients.
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Affiliation(s)
- Gaby Jabbour
- Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Ruben Peralta
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
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Park SJ, Kim DH, Choi CI, Yun SP, Kim JH, Seo HI, Jo HJ, Jun TY. Necrotizing soft tissue infection: analysis of the factors related to mortality in 30 cases of a single institution for 5 years. Ann Surg Treat Res 2016; 91:45-50. [PMID: 27433464 PMCID: PMC4942538 DOI: 10.4174/astr.2016.91.1.45] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/09/2016] [Accepted: 04/05/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Necrotizing soft tissue infection is the infection of the soft tissue with necrotic changes. It is rare, but results in high mortality. We analyzed the characteristics of patients, prognosis, and mortality factors after reviewing 30 cases of a single hospital for 5 years. METHODS From January 2009 to December 2013, 30 patients diagnosed with necrotizing fasciitis or Fournier's gangrene in Pusan National University Hospital were enrolled for this study. The following parameters were analyzed retrospectively: demographics, infection site, initial laboratory finding, initial antibiotics, isolated microorganisms, number of surgeries, time to first operation, length of intensive care unit, and total hospital stays. RESULTS The overall mortality rate was 23.3%. Mean body mass index (BMI) of the survival group (24.7 ± 5.0 kg/m(2)) was significantly higher than the nonsurvival group (22.0 ± 1.4 kg/m(2), P = 0.029). When BMI was less than 23 kg/m(2), the mortality rate was significantly higher (P = 0.025). Two patients (6.7%) with chronic kidney disease requiring hemodialysis died (P = 0.048). Initial WBC count (>13×10(3)/µL), CRP (>26.5 mg/dL), and platelet (PLT) count (<148×10(3)/µL) were found to have negative impact on the prognosis of necrotizing soft tissue infection. Factors such as potassium level, blood urea nitrogen (>27.6 mg/dL), serum creatinine (>1.2 mg/dL) that reflected kidney function were significant mortality factors. CONCLUSION Patients with low BMI or abnormal values of WBC count, CRP, and PLT count reflecting the degree of infection or abnormal renal function will need more intensive care.
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Affiliation(s)
- Sung Jin Park
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Dong Heon Kim
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Chang In Choi
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Sung Pil Yun
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Jae Hun Kim
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Hyung Il Seo
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Hong Jae Jo
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Tae Yong Jun
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
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Kulkarni M, Vijay Kumar G, Sowmya G, Madhu C, Ramya S. Necrotizing soft-tissue infection: laboratory risk indicator for necrotizing soft tissue infections score. J Lab Physicians 2015; 6:46-9. [PMID: 24696561 PMCID: PMC3969643 DOI: 10.4103/0974-2727.129092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Necrotizing soft tissue infections (NSTI) can be rapidly progressive and polymicrobial in etiology. Establishing the element of necrotizing infection poses a clinical challenge. A 64-year-old diabetic patient presented to our hospital with a gangrenous patch on anterior abdominal wall, which progressed to an extensive necrotizing lesion within 1 week. Successive laboratory risk indicator for necrotizing softtissue infections (LRINEC) scores confirmed the necrotizing element. Cultures yielded Enterococci, Acinetobacter species and Apophysomyces elegans and the latter being considered as an emerging agent of Zygomycosis in immunocompromised hosts. Patient was managed with antibiotics, antifungal treatment and surgical debridement despite which he succumbed to the infection. NSTI's require an early and aggressive management and LRINEC score can be applied to establish the element of necrotizing pathology. Isolation of multiple organisms becomes confusing to establish the etiological role. Apophysomyces elegans, which was isolated in our patient is being increasingly reported in cases of necrotizing infections and may be responsible for high morbidity and mortality. This scoring has been proposed as an adjunct tool to Microbiological diagnosis when NSTI's need to be diagnosed early and managed promptly to decrease mortality and morbidity, which however may not come in handy in an immunocompromised host with polymicrobial aggressive infection.
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Affiliation(s)
- Madhuri Kulkarni
- Department of Microbiology, JSS Medical College, Mysore, Karnataka, India
| | - Gs Vijay Kumar
- Department of Microbiology, JSS Medical College, Mysore, Karnataka, India
| | - Gs Sowmya
- Department of Microbiology, JSS Medical College, Mysore, Karnataka, India
| | - Cp Madhu
- Department of Microbiology, JSS Medical College, Mysore, Karnataka, India
| | - Sr Ramya
- Department of Microbiology, JSS Medical College, Mysore, Karnataka, India
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Abstract
Left colon perforation usually occurs in complicated diverticulitis or cancer. The most frequent signs are intraperitoneal abscess or peritonitis. In cases of retroperitoneal colonic perforation, diagnosis may be difficult. A 59-year-old woman presented with left thigh pain and with abdominal discomfort associated with mild dyspnea. Computed tomography scan showed air bubbles and purulent collection in the retroperitoneum, with subcutaneous emphysema extending from the left thigh to the neck. Computed tomography scan also revealed portal vein gas and thrombosis with multiple liver abscesses. An emergency laparotomy revealed a perforation of the proximal left colon. No masses were found. A left colectomy was performed. The retroperitoneum was drained and washed extensively. A negative pressure wound therapy was applied. A second-look laparotomy was performed 48 hours later. The retroperitoneum was drained and an end colostomy was performed. Intensive Care Unit postoperative stay was 9 days, and the patient was discharged on the 32nd postoperative day. Pneumoretroperitoneum and pneumomediastinum are rare signs of colonic retroperitoneal perforation. The diagnosis may be delayed, especially in the absence of peritoneal irritation. Clinical, laboratory, and especially radiologic parameters might be useful. Surgical treatment must be prompt to improve prognosis.
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Abstract
Necrotizing fasciitis is a rare, rapidly progressive severe bacterial soft tissue infection with a high mortality rate. While necrotizing fasciitis classically involves the trunk, groin/perineum, lower limbs, and postoperative wound sites, primary involvement of the eyelids is a rare but well known entity. We present a 33-year-old female patient who developed periocular necrotizing fasciitis after local retrobulbar anesthesia injection and facial block for cataract surgery in the left eye and canthotomy/cantholysis for treatment of moderate retrobulbar hemorrhage in the same eye. Surgical debridement was done and necrotic foul-smelling eyelid and deep orbital tissues were removed, and culture grew Staphylococcus aureus. Despite initial surgical debridement and intravenous antibiotic therapy, the disease progressed rapidly; orbital exenteration was considered, but the patient declined the surgery and self-discharged. Periocular necrotizing fasciitis remains predominantly a clinical diagnosis, and is often missed early in its presentation because of the difficulty in distinguishing it from other common soft tissue infections, especially in the presence of surgical wounds and retrobulbar hemorrhage. A high index of suspicion, early recognition, and prompt therapeutic interventions are indispensable for optimal visual outcome and patient survival.
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Affiliation(s)
- Yeshigeta Gelaw
- Department of Ophthalmology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Aemero Abateneh
- Department of Ophthalmology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
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20
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Moiyadi AV, Shetty P, Biswas S. Fulminant post-craniotomy wound infection and meningitis with pneumocephalus caused by Acinetobacter baumannii: An unusual presentation. J Neurosci Rural Pract 2013; 4:S136-7. [PMID: 24174785 PMCID: PMC3808047 DOI: 10.4103/0976-3147.116462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Aliasgar V Moiyadi
- Department of Neurosurgery, Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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V. K, Hiremath BV, V. A I. Necrotising soft tissue infection-risk factors for mortality. J Clin Diagn Res 2013; 7:1662-5. [PMID: 24086868 PMCID: PMC3782925 DOI: 10.7860/jcdr/2013/5535.3240] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 06/22/2013] [Indexed: 11/24/2022]
Abstract
UNLABELLED Necrotising Soft Tissue Infection is a rapidly progressing fatal disorder, the prognosis of which depends on early diagnosis and management. OBJECTIVE In this study, our objective was to assess the factors contributing to mortality due to NSTI. METHODS A retrospective review of the records of all patients with NSTI involving fascia, skin or muscle between January 2007 and December 2011, was performed. The atiology, predisposing factors, risk factors, causative microbiological organisms and the clinical outcomes associated with mortality were studied. Statistical Data: Descriptive statistics comprising of proportion(%) presented. Chi-square test was employed to assess the statistical significance in the distribution of various known risk factors between the survivors and non-survivors. A 'p' value less than 0.05 was considered significant. RESULTS Sixty patients records were reviewed. Fifty-one patients (85%) were males and nine (15%) were females. Mean age was 46.57 years (+/- 20.60) ranging from 15-83 years. All the patients were treated by debridement & wide spectrum antibiotics. Mono-microbial atiology being found in 27 patients (63.3%) and polymicrobial culture was isolated in 13 patients (36.7%), with E-coli and staphylococci being the most common organisms to be isolated. In most patients, multiple debridements were done. The overall mortality rate was estimated to be 25%. Age, aatiology, diabetes mellitus, hypoalbuminemia, alcohol, site of infection, bacteriology etc. were the risk factors associated with mortality, that were evaluated. Diabetes mellitus was the most common associated risk factor found in 32 patients (53.3%), though not statistically significant. Increasing age (>50 years, p value = 0.016), raised Serum Creatinine (>1.2mg/dl, p-value = 0.023) and delayed surgical intervention(>24 hours p value= 0.006) were the risk factors associated with Mortality in NSTI that were statistically significant. CONCLUSION Despite the use of appropriate antibiotic treatment, aggressive debridement & resuscitation, NSTI still leads to a high mortality & morbidity. In this series, there is high mortality associated with increasing age, raised serum creatinine and delayed surgical intervention. The mortality rate (25%) is comparable with other studies.
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Affiliation(s)
- Kalaivani V.
- Associate Professor, Department of Surgery, M S Ramaiah Medical College and Teaching Hospital, India
| | - Bharati V. Hiremath
- Professor, Department of Surgery, M S Ramaiah Medical College and Teaching Hospital, India
| | - Indumathi V. A
- Professor, Department of Microbiology, M S Ramaiah Medical College and Teaching Hospital, India
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Bartzatt R, Cirillo SLG, Cirillo JD. Antibacterial Derivatives of Ciprofloxacin to Inhibit Growth of Necrotizing Fasciitis Associated Penicillin Resistant Escherichia coli. JOURNAL OF PHARMACEUTICS 2013; 2013:517638. [PMID: 26555983 PMCID: PMC4590791 DOI: 10.1155/2013/517638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 04/09/2013] [Accepted: 04/10/2013] [Indexed: 11/17/2022]
Abstract
Escherichia coli (E. coli) is associated with necrotizing fasciitis (type I) and can induce enough damage to tissue causing hypoxia. Three ester derivatives of the broad-spectrum antibiotic ciprofloxacin were placed into bacteria culture simultaneously with the parent ciprofloxacin (drug 1) to ascertain the level of antibacterial activity. The n-propyl (drug 2), n-pentyl (drug 3), and n-octyl (drug 4) esters of ciprofloxacin were synthesized under mixed phase conditions and by microwave excitation. The formation of ester derivatives of ciprofloxacin modified important molecular properties such as Log P and polar surface area which improves tissue penetration, yet preserved strong antibacterial activity. The Log P values for drugs 1, 2, 3, and 4 became -0.701, 0.437, 1.50, and 3.02, respectively. The polar surface areas for drugs 1, 2, 3, and 4 were determined to be 74.6 Angstroms(2), 63.6 Angstroms(2), 63.6 Angstroms(2), and 63.6 Angstroms(2), respectively. These values of Log P and polar surface area improved tissue penetration, as indicated by the determination of dermal permeability coefficient (K p ) and subsequently into the superficial fascial layer. All drugs induced greater than 60% bacterial cell death at concentrations less than 1.0 micrograms/milliliter. The ester derivatives of ciprofloxacin showed strong antibacterial activity toward penicillin resistant E. coli.
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Affiliation(s)
- Ronald Bartzatt
- University of Nebraska, College of Arts & Sciences, Durham Science Center, Department of Chemistry, Omaha, NE 68182, USA
| | - Suat L. G. Cirillo
- Texas A & M Health Science Center, Department of Microbial and Molecular Pathogenesis, Bryan, TX 77807, USA
| | - Jeffrey D. Cirillo
- Texas A & M Health Science Center, Department of Microbial and Molecular Pathogenesis, Bryan, TX 77807, USA
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Mooney S, Tog C, Lim HK, Sweeney T. Chemical myofascial necrosis: a rare complication of laparoscopic nephrectomy. ANZ J Surg 2013; 83:84-5. [PMID: 23350977 DOI: 10.1111/ans.12038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Samantha Mooney
- General Surgery Department, Austin Hospital, Heidelberg, Victoria, Australia
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Das DK, Baker MG, Venugopal K. Risk factors, microbiological findings and outcomes of necrotizing fasciitis in New Zealand: a retrospective chart review. BMC Infect Dis 2012; 12:348. [PMID: 23234429 PMCID: PMC3538518 DOI: 10.1186/1471-2334-12-348] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 12/10/2012] [Indexed: 02/06/2023] Open
Abstract
Background The incidence and mortality from necrotizing fasciitis (NF) are increasing in New Zealand (NZ). Triggered by a media report that traditional Samoan tattooing was causing NF, we conducted a chart review to investigate the role of this and other predisposing and precipitating factors and to document NF microbiology, complications and interventions in NZ. Methods We conducted a retrospective review of 299 hospital charts of patients discharged with NF diagnosis codes in eight hospitals in NZ between 2000 and 2006. We documented and compared by ethnicity the prevalence of predisposing and precipitating conditions, bacteria isolated, complications and interventions used. Results Out of 299 charts, 247 fulfilled the case definition. NF was most common in elderly males. Diabetes was the most frequent co-morbid condition, followed by obesity. Nearly a quarter of patients were taking non-steroidal anti-inflammatory drugs (NSAID). Traditional Samoan tattooing was an uncommon cause. Streptococcus pyogenes and Staphylococcus aureus were the two commonly isolated bacteria. Methicillin-resistant Staphylococcus aureus was implicated in a relatively small number of cases. Shock, renal failure, coagulation abnormality and multi-organ dysfunction were common complications. More than 90% of patients underwent surgical debridement, 56% were admitted to an intensive care unit (ICU) and slightly less than half of all patients had blood product transfusion. One in six NF cases had amputations and 23.5% died. Conclusion This chart review found that the highest proportion of NF cases was elderly males with co-morbidities, particularly diabetes and obesity. Tattooing was an uncommon precipitating event. The role of NSAID needs further exploration. NF is a serious disease with severe complications, high case fatality and considerable use of health care resources.
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Affiliation(s)
- Dilip Kumar Das
- Department of Public Health, University of Otago, Wellington, New Zealand.
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De Angelis B, Cerulli P, Lucilla L, Fusco A, Di Pasquali C, Bocchini I, Orlandi F, Agovino A, Cervelli V. Spontaneous clostridial myonecrosis after pregnancy - emergency treatment to the limb salvage and functional recovery: a case report. Int Wound J 2012; 11:93-7. [PMID: 22973988 DOI: 10.1111/j.1742-481x.2012.01072.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Clostridial myonecrosis (CM) is a rare, life threatening necrotizing infection of a skeletal muscle caused by Clostridium perfringens in the majority of cases. The diagnosis may be difficult because of few diagnostic and cutaneous signs early in its course. Standard therapy involves surgical debridements of a devitalized tissue and high-dose organism-specific antibiotic therapy. The hyperbaric oxygen has also showed its usefulness in the treatment of these infections. Autograft systems as tissue replacement, based on bioengineered materials, have been demonstrated to be safe and effective treatments for chronic wounds and a suitable physiotherapy is recommended for the recovery of functional impairments of upper extremities. We present a rare case of CM of right upper limb treated with a combination of standard treatments and new techniques.
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Affiliation(s)
- Barbara De Angelis
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Rome, ItalyRegenerative Surgery, University of Rome Tor Vergata, Rome, ItalyClinical Laboratory of Experimental Neurorehabilitation, Santa Lucia Foundation, I.R.C.C.S., Rome, Italy
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27
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Rashid OM, Nagahashi M, Takabe K. Management of massive soft tissue defects: The use of INTEGRA® artificial skin after necrotizing soft tissue infection of the chest. J Thorac Dis 2012; 4:331-5. [PMID: 22754676 DOI: 10.3978/j.issn.2072-1439.2012.05.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 05/19/2012] [Indexed: 11/14/2022]
Abstract
Necrotizing soft tissue infection, such as necrotizing fasciitis, is a group of highly lethal infections especially when the chest is involved due to increased risk of pulmonary complications. Because aggressive radical debridement of all poorly perfused tissue is required, patients frequently suffer from massive skin defects, which often requires autograft skin grafting or myocutaneous flaps. However, options are limited in patients with limited autograft donor availability, or questionable underlying wound bed viability, such as in scleroderma. Here, we report the case of a 49 year old female with scleroderma who suffered from a necrotizing soft tissue infection of the chest extending to her right upper arm, underwent multiple radical debridements, and reconstruction of the consequent massive chest wall defect with INTEGRA® bilaminar dermal regeneration template. This approach required a thinner skin graft without flaps, allowed for the inherently diseased donor site to heal adequately, and avoided major infections and wound complications. This report highlights an important management option for this challenging disease.
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Affiliation(s)
- Omar M Rashid
- Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University and Massey Cancer Center, Richmond, Virginia, USA
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28
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Necrotizing fasciitis: is the bacterial spectrum changing? Langenbecks Arch Surg 2012; 398:153-9. [DOI: 10.1007/s00423-012-0983-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 07/17/2012] [Indexed: 11/25/2022]
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29
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Severe Soft Tissue Infection. Plast Surg (Oakv) 2012. [DOI: 10.1007/978-1-84882-116-3_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cutaneous Manifestations of Infectious Diseases. ATLAS OF DERMATOLOGY IN INTERNAL MEDICINE 2012. [PMCID: PMC7178861 DOI: 10.1007/978-1-4614-0688-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Skin infections account for a significant portion of dermatologic diseases. Infections of the skin and subcutaneous tissues are highly diverse in respect to incidence, etiologic organisms, and clinical manifestations. Most cases are potentially treatable, thus, it is vital for the clinician to become familiar with the cutaneous expression of local and systemic processes. This chapter covers the clinical presentation, diagnosis, and treatment of the most common bacterial, viral, and fungal mucocutaneous infections encountered in internal medicine.
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Dexel J, Schneiders W, Kasten P. Subcutaneous emphysema of the upper extremity after elbow arthroscopy. Arthroscopy 2011; 27:1014-7. [PMID: 21616628 DOI: 10.1016/j.arthro.2010.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 12/26/2010] [Accepted: 12/29/2010] [Indexed: 02/02/2023]
Abstract
Subcutaneous emphysema of the upper extremity is rare. Crepitation on physical examination and visible gas on radiographs raise the concern of gas gangrene due to gas-producing bacteria. Rapid establishment of a differential diagnosis is necessary to initiate proper treatment. We present a case of subcutaneous emphysema after elbow arthroscopy caused by a noninfectious genesis. A 59-year-old woman with loose bodies in her left elbow due to mild degenerative joint disease and restricted range of motion was offered an elbow arthroscopy with removal of loose bodies and arthrolysis. Postoperatively, the elbow was actively put alternatively in maximum extension and flexion. On the first postoperative day, rapidly ascending swelling and subcutaneous crepitation starting from the hand to the forearm were noted. There was no clinical evidence of infection. Radiographs showed subcutaneous air. Frequent blood tests and clinical evaluation ruled out a potentially life-threatening bacterial infection, and the signs resolved after 1 week without surgical treatment. Presumably, the intensive postoperative range-of-motion exercises led to a sucking in of air into the wound during each movement. This case illustrates that it is important to differentiate nonbacterial from bacterial causes of soft-tissue gas formation to initiate the appropriate treatment.
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Affiliation(s)
- Julian Dexel
- Department of Orthopaedic Surgery, Carl Gustav Carus University of Dresden, Dresden, Germany
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Kish TD, Chang MH, Fung HB. Treatment of skin and soft tissue infections in the elderly: A review. ACTA ACUST UNITED AC 2011; 8:485-513. [PMID: 21356502 DOI: 10.1016/s1543-5946(10)80002-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND Skin and soft tissue infections (SSTIs) have become the second most common type of infection among persons residing in long-term care facilities. OBJECTIVE The purpose of this article was to review the latest information on SSTIs among the elderly, including age-related changes, challenges, and treatment strategies in the era of emerging bacterial resistance. METHODS Relevant information was identified through a search of MEDLINE (1970-April 2010), International Pharmaceutical Abstracts (1970-April 2010), and Google Scholar using the terms skin and soft tissue infection, skin and skin structure infection, cellulitis, treatment guidelines, and elderly. Additional publications were found by searching the reference lists of the identified articles. Trials published since 1970 were selected for this review if they prospectively evaluated mostly adults (≥18 years of age), included >50 patients, and reported diagnostic criteria as well as clinical outcomes in patients treated for simple or complicated SSTIs. RESULTS Fifty-eight of 664 identified studies were selected and included in this review. A search of the literature did not identify any prospective clinical trials that were conducted exclusively in the elderly. Information on the treatment of SSTIs in the elderly was based solely on clinical studies that were conducted in adults in general. As recommended by the Infectious Diseases Society of America (IDSA) 2008 update, SSTIs should be suspected in elderly patients who have skin lesions and present with a decline in functional status, with or without fever. Patients who present with symptoms of systemic toxicity should be hospitalized for further evaluation. Current challenges in the management of SSTIs include the rapid emergence of community-acquired, methicillin-resistant Staphylococcus aureus (CA-MRSA), the emergence of macrolide-resistant streptococci within the past decade, and the lack of a reliable algorithm to differentiate potentially life-threatening SSTIs that require aggressive interventions and prompt hospitalization from those that can be managed in an outpatient setting. S aureus was the most common cause of SSTIs, being isolated in 42.8% (5015/11,723) of wounds, followed by streptococci. Common SSTIs in the elderly such as shingles, diabetic foot infections, infected pressure ulcers, and scabies, and their treatment were also discussed. Based on reviews of published trials, treatment of simple SSTIs generally consisted of administration of agents with activity against S aureus and Streptococcus species such as a penicillinase-resistant β-lactam, a first-generation cephalosporin, or clindamycin. Broadening of the antimicrobial spectrum to include gram-negative and anaerobic organisms should be implemented for complicated SSTIs such as diabetic foot infections and infected pressure ulcers. Local rates of MRSA, CA-MRSA, and macrolide-resistant streptococci should be considered when selecting empiric therapy. CONCLUSIONS A search of the literature did not identify any prospective clinical trials on the treatment of SSTIs in the elderly; therefore, it is recommended to follow treatment based on the current IDSA guidelines. More research and publications are needed to establish proper selection of antimicrobial agents, treatment strategies, and duration of therapy of SSTIs in the elderly population.
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Affiliation(s)
- Troy D Kish
- Pharmacy Service, James J. Peters Veterans Affairs Medical Center, Bronx, New York 10468, USA
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Kao TL, Kao ML. A fatal case of necrotizing Aeromonas schubertii fasciitis after penetrating injury. Am J Emerg Med 2011; 30:258.e3-5. [PMID: 21247722 DOI: 10.1016/j.ajem.2010.10.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 10/23/2010] [Indexed: 11/19/2022] Open
Abstract
Necrotizing fasciitis is an uncommon but life-threatening condition with a high associated mortality and morbidity. Most infections are polymicrobial, another distinct form of necrotizing fasciitis that occurred by penetrating freshwater trauma, such as fishing or wading in wet fields. Aeromonas species are responsible. The rapidity of the infectious process is similar to that of clostridial infection, but gas production is not a consistent feature. We report a patient who presented with fever, chills, and bullae on left forearm, despite antibiotics and wound debridement; the infection extend to mid humerus with a rapid onset of skin necrosis and progressive sepsis. Aeromonas schubertii fasciitis is particularly virulent. An apparent superficial cellulitis that fails to respond to standard therapy must raise suspicion of a more extensive underlying subcutaneous infection. Aggressive surgical debridement and antibiotic coverage for gram-negative rods are the essential features of treatment. Delay caused by a mistaken diagnosis of cellulitis and subsequent inadequate debridement would likely prove fatal.
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Affiliation(s)
- Ta-Lun Kao
- Department of Critical care Medicine, Changhua Christian Hospital, Changhua, Taiwan, ROC
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34
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Ryssel H, Germann G, Kloeters O, Radu CA, Reichenberger M, Gazyakan E. Necrotizing fasciitis of the extremities: 34 cases at a single centre over the past 5 years. Arch Orthop Trauma Surg 2010; 130:1515-22. [PMID: 20499245 DOI: 10.1007/s00402-010-1101-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Worldwide the incidence of necrotizing fasciitis (NF) is on the rise. This rapidly progressive infection is a true infectious disease emergency due to its high morbidity and mortality. The mainstay of therapy is prompt surgical debridement, intravenous antibiotics, and supportive care with fluid and electrolyte management. Because of its high mortality rate, patients are increasingly referred to burn centres for specialized wound and critical care issues. METHODS A retrospective chart review was performed of 34 consecutive patients over a 5-year period with NF of the upper and/or lower extremities that required surgical debridement and reconstruction. RESULTS The overall survival rate was 96%, with an average length of hospital stay of 64.0 ± 5.5 days. The time until the first operation was 1.3 days. The average age of the patients was 56.7 ± 10.6 years. The patients averaged 1.6 relevant comorbidities. One patient who had five comorbidities died. The affected total body surface (TBS) averaged 8.2 ± 2.1%. CONCLUSION Early recognition and treatment remain the most important factors influencing survival in NF. Yet, early diagnosis of the condition is difficult due to its similarities with other soft-tissue disorders. Repeated surgical debridement and incisional drainage continues to be essential for the survival. However, these infections continue to be a source of high morbidity, mortality and significant healthcare resource consumption. These challenging patients are best served with prompt diagnosis, immediate radical surgical debridement and aggressive critical care management. Referral to a major burn centre may help to provide optimal surgical intervention, wound care and critical care management.
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Affiliation(s)
- Henning Ryssel
- Department of Hand-, Plastic- and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand-Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
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Abstract
An understanding of the pathogenesis of infection, and the complex and fascinating 'relationship', or interaction, between the infecting organism and the host are advantageous when caring for patients with infections/infectious diseases, particularly as many of the clinical features of infection are as a consequence of the defence mechanisms mounted by the immune system. This article aims to provide a brief overview of the pathogenesis of infection, explaining how the two branches of the immune system, the innate/natural immune response, and the adaptive/acquired immune response, mount an attack against invading bacteria. Reference is made to bacteria such as Staphylococcus aureus, Clostridium difficile, Streptococcus pyogenes, Neisseria meningitidis and Mycobacterium tuberculosis, and their effect on the human host and the immune response, through the processes of attachment/entry, evasion of host defences, replication, and damage to the host.
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Affiliation(s)
- Debbie Weston
- East Kent Hospitals University NHS Foundation Trust, UK
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36
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Turecki MB, Taljanovic MS, Stubbs AY, Graham AR, Holden DA, Hunter TB, Rogers LF. Imaging of musculoskeletal soft tissue infections. Skeletal Radiol 2010; 39:957-71. [PMID: 19714328 DOI: 10.1007/s00256-009-0780-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 08/03/2009] [Accepted: 08/06/2009] [Indexed: 02/02/2023]
Abstract
Prompt and appropriate imaging work-up of the various musculoskeletal soft tissue infections aids early diagnosis and treatment and decreases the risk of complications resulting from misdiagnosis or delayed diagnosis. The signs and symptoms of musculoskeletal soft tissue infections can be nonspecific, making it clinically difficult to distinguish between disease processes and the extent of disease. Magnetic resonance imaging (MRI) is the imaging modality of choice in the evaluation of soft tissue infections. Computed tomography (CT), ultrasound, radiography and nuclear medicine studies are considered ancillary. This manuscript illustrates representative images of superficial and deep soft tissue infections such as infectious cellulitis, superficial and deep fasciitis, including the necrotizing fasciitis, pyomyositis/soft tissue abscess, septic bursitis and tenosynovitis on different imaging modalities, with emphasis on MRI. Typical histopathologic findings of soft tissue infections are also presented. The imaging approach described in the manuscript is based on relevant literature and authors' personal experience and everyday practice.
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Affiliation(s)
- Marcin B Turecki
- Department of Radiology, University of Arizona, Tucson, AZ 85724, USA.
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Matriderm® in depth-adjusted reconstruction of necrotising fasciitis defects. Burns 2010; 36:1107-11. [PMID: 20392567 DOI: 10.1016/j.burns.2009.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 10/28/2009] [Accepted: 12/05/2009] [Indexed: 12/15/2022]
Abstract
Necrotising fasciitis (NF) and Fournier's gangrene are still a source of high morbidity and mortality and a significant health-care resource consumption. These difficult cases are increasingly being referred to burn centres for specialised wound and critical care issues. Besides the total body surface area (TBSA) affected, location, co-morbidities, age and an immediate surgical treatment are important prognostic factors. The treatment of these patients is challenging and best performed by prompt diagnosis, immediate radical surgical debridement and aggressive critical care management. Referral to a major burn centre may help provide optimal surgical intervention, wound care and critical care management.As soon as the patient is stabilised, reconstruction of the injured areas becomes the main focus. As often seen, complete loss of dermal structures needs a depth adjusted--'multilayer'--reconstruction especially in critical areas. In modern reconstructive surgery, concepts of layer-specific reconstruction, including dermal substitution have to be considered. In this article, we present our recent experiences of five patients with NF who underwent dermal reconstruction with Matriderm® not only for better skin quality but also in some cases as an alternative to flap surgery when joint capsules or tendons were exposed.
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Wamisho BL, Bates J, Tompkins M, Islam R, Nyamulani N, Ngulube C, Mkandawire NC. Ward round--crocodile bites in Malawi: microbiology and surgical management. Malawi Med J 2009; 21:29-31. [PMID: 19780476 DOI: 10.4314/mmj.v21i1.10986] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We present a case series of 5 patients admitted over 5 months to Queen Elizabeth Central Hospital who had sustained injuries from a crocodile bite. Three patients required amputation of a limb. The severe soft tissue injury associated with a crocodile bite and the unusual normal oral flora of the crocodile create challenges in treatment. Progressive tissue destruction and haemolysis are complications of such infected wounds. An antibiotic regime is recommended that covers gram negative rods, anaerobes and may include doxycycline, as well as the need to have a low threshold for early amputation.
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Affiliation(s)
- Biruk L Wamisho
- College of Medicine, Department of Surgery, Malawi, P.O. Box 122201, Addis Ababa, Ethiopia.
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Chang YC, Lee CH, Tseng CL, Chen JC. Children with lethal streptococcal fasciitis after a minor contusion injury. Am J Emerg Med 2009; 27:1017.e3-5. [PMID: 19857429 DOI: 10.1016/j.ajem.2008.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 12/04/2008] [Indexed: 11/17/2022] Open
Abstract
Necrotizing fasciitis is a severe life-threatening soft tissue infection characterized by rapidly spreading necrosis of the fascia and the subcutaneous tissue. Mortality as a result of streptococcal necrotizing fasciitis has been associated with the presence of hypotension, streptococcal toxic shock syndrome, or bacteremia in the literature. These infections are rare in children, and the diagnosis should be considered in the presence of any soft tissue infection presenting with signs of toxicity and marked wound edema. In addition, traumatic compartment syndrome has also gained public attention. This condition is also potentially lethal if diagnosis and management are delayed, especially in patients with swollen limbs without fracture. A high index of suspicion is most important when there is a paucity of specific cutaneous findings early in the course of the disease. The diagnosis of necrotizing fasciitis should be considered for any individual who has unexplained limb pain. Even for treating patients with minor trauma, the emergency department physician should keep a high level of suspicion of the possibility of a fatal outcome from the subsequent invasive streptococcal infection.
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Affiliation(s)
- Yu-Che Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
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Successful management of spontaneous Clostridium septicum myonecrosis. J Plast Reconstr Aesthet Surg 2009; 62:e391-3. [DOI: 10.1016/j.bjps.2007.12.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2007] [Revised: 12/06/2007] [Accepted: 12/16/2007] [Indexed: 11/20/2022]
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George ME, Rueth NM, Skarda DE, Chipman JG, Quickel RR, Beilman GJ. Hyperbaric oxygen does not improve outcome in patients with necrotizing soft tissue infection. Surg Infect (Larchmt) 2009; 10:21-8. [PMID: 18991520 DOI: 10.1089/sur.2007.085] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with necrotizing soft tissue infections (NSTIs) require prompt surgical debridement, appropriate intravenous antibiotics, and intensive support. Despite aggressive treatment, their mortality and morbidity rates remain high. The benefit of hyperbaric oxygen (HBO) as an adjunctive treatment is controversial. We investigated the effect of HBO in treating NSTIs. METHODS We analyzed clinical data retrospectively for 78 patients with NSTIs: 30 patients at one center were treated with surgery, antibiotics, and supportive care; 48 patients at a different center received adjunctive HBO treatment. We compared the two groups in terms of demographic characteristics, risk factors, NSTI microbiology, and patient outcomes. To identify variables associated with higher mortality rates, we used logistic regression analysis. RESULTS Demographic characteristics and risk factors were similar in the HBO and non-HBO groups. The mean patient age was 49.5 years; 37% of the patients were female, and 49% had diabetes mellitus. Patients underwent a mean of 3.0 excisional debridements. The median hospital length of stay was 16.5 days; the median duration of antibiotic use was 15.0 days. In 36% of patients, cultures were polymicrobial; group A Streptococcus was the organism most commonly isolated (28%). We identified no statistically significant differences in outcomes between the two groups. The mortality rate for the HBO group (8.3%) was lower, although not significantly different (p = 0.48), than that observed for the non-HBO group (13.3%). The number of debridements was greater in the HBO group (3.0; p = 0.03). The hospital length of stay and duration of antibiotic use were similar for the two groups. Multivariable analysis showed that hypotension on admission and immunosuppression were significant independent risk factors for death. CONCLUSIONS Adjunctive use of HBO to treat NSTIs did not reduce the mortality rate, number of debridements, hospital length of stay, or duration of antibiotic use. Immunosupression and early hypotension were important risk factors associated with higher mortality rates in patients with NSTIs.
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Affiliation(s)
- Mark E George
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA
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Shome D, Jain V, Jayadev C, Shah K, Natarajan S. Periocular necrotizing fasciitis associated with kerato-conjunctivitis and treated with medical management: a case report. Indian J Ophthalmol 2008; 56:231-2. [PMID: 18417825 PMCID: PMC2636108 DOI: 10.4103/0301-4738.40363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report a 25-year-old systemically healthy male who presented
with periocular necrotizing fasciitis (NF) in the left eyelid. This
was associated with the presence of immunologically mediated
marginal kerato-conjunctivitis, in the same eye. This potentially
dangerous lid infection and the associated ocular surface infection
resolved successfully, with medical management. We report this
case to highlight the successful conservative management of
periocular NF and the hitherto unreported anterior segment
involvement.
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Affiliation(s)
- Debraj Shome
- Department of Ocular Oncology, Tata Memorial Centre, Mumbai, India.
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Lu MS, Chen CM, Huang YK, Liu YH, Kao CL. Devastating chest wall necrotizing fasciitis following pigtail catheter drainage. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.rmedc.2007.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Amitai A, Sinert R. Necrotizing Fasciitis as the Clinical Presentation of a Retroperitoneal Abscess. J Emerg Med 2008; 34:37-40. [DOI: 10.1016/j.jemermed.2007.03.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 07/25/2006] [Accepted: 11/16/2006] [Indexed: 10/22/2022]
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Yilmazlar T, Ozturk E, Alsoy A, Ozguc H. Necrotizing soft tissue infections: APACHE II score, dissemination, and survival. World J Surg 2007; 31:1858-1862. [PMID: 17610007 DOI: 10.1007/s00268-007-9132-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND First described more than a century ago, necrotizing soft tissue infections (NSTIs) continue to cause high mortality and morbidity. The aim of this study was to elucidate the factors affecting the outcome of patients presenting with an NSTI. METHODS To determine the factors affecting mortality from NSTIs, the records of 67 patients were retrospectively assessed for the following parameters: age, sex, time between initiation of symptoms and admission to the clinic, presence of systemic coexisting disease, APACHE II score, origin of infection, dissemination of the NSTI, and method of therapy. RESULTS The patients were 41 men (61.2%) and 26 women (38.8%) with a mean age of 54.9 +/- 1.73 years. The overall mortality rate was 49% (33/67). Multivariate analysis determined that APACHE II scores of 13 or higher (p = 0.001) and NSTI dissemination (p = 0.02) were risk factors affecting the mortality of patients with NSTIs. CONCLUSION By considering these two factors, more accurate outcome prediction may be possible, which may be useful for directing the management of patients with NSTIs.
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Affiliation(s)
- Tuncay Yilmazlar
- Department of General Surgery, Uludag University School of Medicine, Gorukle Kampusu, Bursa, 21900, Turkey.
- Uludag Universitesi Tip Fak. Genel Cerrahi ABD, Gorukle, Bursa, Turkey.
| | - Ersin Ozturk
- Department of General Surgery, Uludag University School of Medicine, Gorukle Kampusu, Bursa, 21900, Turkey
| | - Alpaslan Alsoy
- Department of General Surgery, Uludag University School of Medicine, Gorukle Kampusu, Bursa, 21900, Turkey
| | - Halil Ozguc
- Department of General Surgery, Uludag University School of Medicine, Gorukle Kampusu, Bursa, 21900, Turkey
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Brachelente C, Wiener D, Malik Y, Huessy D. A case of necrotizing fasciitis with septic shock in a cat caused by Acinetobacter baumannii. Vet Dermatol 2007; 18:432-8. [DOI: 10.1111/j.1365-3164.2007.00624.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
PURPOSE To update the practitioner with causes, diagnosis, and treatment options for necrotizing fasciitis. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in better understanding the pathophysiology, diagnosis, and treatment of necrotizing fasciitis. OBJECTIVES After reading this article and taking this test, the reader should be able to: 1. Identify the risk factors and causes of necrotizing fasciitis (NF). 2. Describe the clinical presentation and diagnosis of NF. 3. Explain the treatment options for NF.
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Affiliation(s)
- Richard Sal Salcido
- Department of Rehabilitation Medicine, Institute of Medicine and Bioengineering, University of Pennsylvania Health System, Philadelphia, PA, USA
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Golash V. Necrotizing fasciitis following laparoscopic total extra peritoneal repair of left inguinal hernia. J Minim Access Surg 2007; 3:26-8. [PMID: 20668615 PMCID: PMC2910376 DOI: 10.4103/0972-9941.30683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 01/05/2007] [Indexed: 11/04/2022] Open
Abstract
There are rare reports of necrotizing fasciitis (NF) following laparoscopic surgery. The clinical presentation of this condition may be delayed due to non-specific symptoms and sign. The diagnosis is essentially clinical and early recognition is crucial in the management. We present a case of NF of the lower abdominal wall extending to thigh, scrotum and perianal area following the laparoscopic extraperitoneal repair of left inguinal hernia managed with extensive debridment, removal of mesh, antibiotic, and skin grafting. He was seen 6 months after his surgeries and had no disability. The extensive search on Medline, Medscape, and Google engine revealed only one case report of NF following laparoscopic total extraperitoneal repair of inguinal hernia that died and this is the second case report and the only surviving one.
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Affiliation(s)
- Vishwanath Golash
- Department of Surgery, Sultan Qaboos Hospital, Salalah, Sultanate of Oman
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Abstract
Necrotizing fasciitis (NF) is a life-threatening condition, consisting of a soft-tissue infection with rapidly progressive, widespread fascial necrosis. NF may be caused by a wide variety of microbes. Indeed, NF may be an infection of one species of bacteria or may be polymicrobial. Prompt diagnosis and treatment are essential. Surgical debridement and antibiotic therapy are the primary treatment options.
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Affiliation(s)
- G G Kihiczak
- Dermatology, New Jersey Medical School, Newark, New Jersey, USA
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