2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections

Sartelli, Massimo; Guirao, Xavier; Hardcastle, Timothy Craig; Kluger, Yoram; Boermeester, Marja A.; Raşa, Kemal; Ansaloni, Luca; Catena, Fausto; Montravers, Philippe; Abu‐Zidan, Fikri M.; Bartoletti, Michele; Bassetti, Matteo; Ben-Ishay, Offir; Biffl, Walter L.; Chiara, Osvaldo; Chiarugi, Massimo; Coimbra, Raúl; Rosa, Francesco Giuseppe De; Simone, Belinda De; Saverio, Salomone Di; Giannella, Maddalena; Gkiokas, George; Khokha, Vladimir; Labricciosa, Francesco M.; Leppäniemi, Ari; Litvin, Andrey; Moore, Ernest E.; Negoi, Ionuț; Pagani, Léonardo; Picetti, Edoardo; Pintar, Tadeja; Pupelis, Guntars; Rubio-Perez, Inés; Sakakushev, Boris; Lohse, Helmut Alfredo Segovia; Sganga, Gabriele; Shelat, Vishal G; Sugrue, Michael; Tarasconi, Antonio; Tranà, Cristian; Ulrych, Jan; Viale, Pierluigi; Catena, Fausto

doi:10.1186/s13017-018-0219-9

Cited by 209 publications

(351 citation statements)

References 162 publications

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“…However, those factors were outside the scope of this review. The goal of the initial surgical procedure for NSTIs is to gain control and prevent further (trans-fascial and hematogenous) spreading of the infection by complete debridement of all the infected and necrotic tissue [1,9]. Sarani et al suggested that each hour delay of surgical treatment can lead to a local spread of the infection as fast as an inch per hour and results in higher chances of systematic spread [24].…”

Section: Discussionmentioning

confidence: 99%

“…Early resection of necrotic and infected tissue results in a lower microbial load. As a result, the immune system combined with broad spectrum antibiotics has better odds at controlling the infection [1,27]. Thus, time is of the essence.…”

Section: Discussionmentioning

confidence: 99%

“…Necrotizing soft tissue infections (NSTIs) are notorious for their acute, aggressive, and rapidly progressive character. Of all NSTIs, necrotizing fasciitis is the most well known and most common NSTI; other NSTIs are myonecrosis and necrotizing cellulitis [1]. Mortality and amputation rates for NSTI are considered high, with described mortality rates varying between 6 and 33% [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…The bacteria causing NSTI can spread rapidly along the fascial planes; therefore, the saying "time is fascia" seems suitable. This resulted in the established belief that source control with early surgical resection of necrotic and infected tissue reduces progression of the infection and improves outcomes [1,7]. However, the achievability of early treatment is sometimes hindered by a prolonged interval between the onset of symptoms and the patient seeking medical care (patient delay), or between hospital presentation and the eventual diagnosis (doctor delay) [8].…”

Section: Introductionmentioning

confidence: 99%

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Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis

et al. 2020

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Background: Although the phrase "time is fascia" is well acknowledged in the case of necrotizing soft tissue infections (NSTIs), solid evidence is lacking. The aim of this study is to review the current literature concerning the timing of surgery in relation to mortality and amputation in patients with NSTIs. Methods: A systematic search in PubMed/MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Controlled Register of Trials (CENTRAL) was performed. The primary outcomes were mortality and amputation. These outcomes were related to the following time-related variables: (1) time from onset symptoms to presentation; (2) time from onset symptoms to surgery; (3) time from presentation to surgery; (4) duration of the initial surgical procedure. For the meta-analysis, the effects were estimated using random-effects meta-analysis models.Result: A total of 109 studies, with combined 6051 NSTI patients, were included. Of these 6051 NSTI patients, 1277 patients died (21.1%). A total of 33 studies, with combined 2123 NSTI patients, were included for quantitative analysis. Mortality was significantly lower for patients with surgery within 6 h after presentation compared to when treatment was delayed more than 6 h (OR 0.43; 95% CI 0.26-0.70; 10 studies included). Surgical treatment within 6 h resulted in a 19% mortality rate compared to 32% when surgical treatment was delayed over 6 h. Also, surgery within 12 h reduced the mortality compared to surgery after 12 h from presentation (OR 0.41; 95% CI 0.27-0.61; 16 studies included). Patient delay (time from onset of symptoms to presentation or surgery) did not significantly affect the mortality in this study. None of the time-related variables assessed significantly reduced the amputation rate. Three studies reported on the duration of the first surgery. They reported a mean operating time of 78, 81, and 102 min with associated mortality rates of 4, 11.4, and 60%, respectively.Conclusion: Average mortality rates reported remained constant (around 20%) over the past 20 years. Early surgical debridement lowers the mortality rate for NSTI with almost 50%. Thus, a sense of urgency is essential in the treatment of NSTI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis

et al. 2020

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“…Linezolid is used for the treatment of complicated skin and soft tissue infections with methicillin-resistant Staphylococcus aureus [1][2][3] and for toxic shock syndrome [4], and has become an important treatment option in empirical antimicrobial therapy in intensive care medicine, e.g., recommended in German guidelines for septic shock with a risk of methicillin-resistant Staphylococcus aureus (MRSA) infection [5]. In addition, linezolid is a frequently used antibiotic for the treatment of vancomycin-resistant Enterococcus (VRE), which is increasingly triggering serious infections in critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

Linezolid Concentrations in Plasma and Subcutaneous Tissue are Reduced in Obese Patients, Resulting in a Higher Risk of Underdosing in Critically Ill Patients: A Controlled Clinical Pharmacokinetic Study

Simon

Busse

Petroff

et al. 2020

JCM

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Background: Linezolid is used for the treatment of soft tissue infections in critically ill patients. However, data for characterizing the pharmacokinetics (PK) and assessing whether effective concentrations are reached at the target site are lacking. We hypothesized that current dosing regimens do not lead to effective concentrations in the plasma and interstitial fluid (ISF) of subcutaneous tissue in obese patients. Methods: As a controlled clinical model, critically ill obese and non-obese patients undergoing intra-abdominal surgery received 600 mg linezolid as a single infusion. Concentrations in the plasma and microdialysate from the ISF of subcutaneous tissue were determined up to 8 h after dosing. Pharmacokinetic analysis was performed by non-compartmental methods. As a therapeutic target, we used f AUC/MIC > 80. Results: Fifteen obese (BMI: 48.7 ± 11.2 kg/m 2 ) and 15 non-obese (23.9 ± 2.1 kg/m 2 ) patients were analyzed. AUC 0-8 in ISF decreased by −1.69 mg*h/L (95% CI: −2.59 to −0.79, p < 0.001) for every 10 kg increase in weight. PK in obese patients were characterized by lower maximal plasma concentrations (median 3.8 vs. 8.3 mg/L, p < 0.001) and a higher volume of distribution (41.0 vs. 30.8 L, p < 0.001), and the therapeutic target was not reached for MIC ≥ 1 mg/L in ISF and ≥ 2 mg/L in plasma. Conclusions: Increasing the weight led to a decrease of linezolid concentrations in the plasma and subcutaneous tissue. The current dosing regimen does not seem to produce sufficient concentrations to kill bacteria with MIC ≥ 2 mg/L, especially as empirical antimicrobial therapy in critically ill obese patients.

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Huge carbuncle leading to necrotizing fasciitis in the COVID‐19 pandemic era

Gheisari

Baghani

Ganji

et al. 2021

Clinical Case Reports

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2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections

Cited by 209 publications

References 162 publications

Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis

Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis

Linezolid Concentrations in Plasma and Subcutaneous Tissue are Reduced in Obese Patients, Resulting in a Higher Risk of Underdosing in Critically Ill Patients: A Controlled Clinical Pharmacokinetic Study

Huge carbuncle leading to necrotizing fasciitis in the COVID‐19 pandemic era

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