Cervical necrotizing fasciitis: Systematic review and analysis of 1235 reported cases from the literature

Gunaratne, Dakshika A.; Tseros, Evan A.; Hasan, Zubair; Kudpaje, Akshay; Suruliraj, Anand; Smith, Mark C.; Riffat, Faruque; Palme, Carsten E.

doi:10.1002/hed.25184

Cited by 100 publications

(157 citation statements)

References 52 publications

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“…Under such circumstances, early tracheotomy is recommended because it is more secure and allows the patient to be moved to a non-critical care unit at an earlier stage, thus reducing the overall costs. [19][20][21] Consistent with the reports by Ridder et al 2 and Palma et al, 22 no secondary infections were observed at the tracheostomy sites in the patients included in our study.…”

Section: Discussionsupporting

confidence: 92%

Multidisciplinary treatment of deep neck infection associated with descending necrotizing mediastinitis: a single-centre experience

Zhou

Zhao

et al. 2019

J Int Med Res

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Objective Deep neck infection (DNI) associated with descending necrotizing mediastinitis (DNM) is a highly lethal condition. This retrospective review was performed to share our experience performing multidisciplinary management of DNI associated with DNM during a 7-year period. Methods We reviewed 16 patients who had been surgically treated for DNM at Peking Union Medical College Hospital from April 2010 to July 2017. The clinical outcomes were analysed to determine the most appropriate therapeutic strategy. Results Five women and 11 men were included in this study. Their mean age was 54.9 ± 14.3 years. DNM-associated infections most commonly occurred secondary to odontogenic infections (n = 10). Thirteen patients required tracheotomy because of tracheal compression. All patients underwent unilateral or bilateral cervicotomy. Six patients with DNM localized in the upper mediastinal space underwent transcervical mediastinal drainage, while 10 patients with DNM extending to the lower mediastinum were treated by cervicotomy and video-assisted thoracoscopic surgery. Three patients died of multiple organ failure. Conclusion Multidisciplinary treatment can achieve favourable outcomes in >80% of patients with DNM. Early diagnosis, proper airway management, and adequate surgical drainage are crucial for reducing mortality in patients with DNM, and minimally invasive procedures also play an important role.

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Section: Discussionsupporting

confidence: 92%

Multidisciplinary treatment of deep neck infection associated with descending necrotizing mediastinitis: a single-centre experience

Zhou

Zhao

et al. 2019

J Int Med Res

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“…Among deep neck space infections, type I NSTI predominate [69]. The most important pathogens are viridans streptococci, staphylococci and Gram-negative anaerobes such as Bacteroides fragilis, Prevotella, Fusobacterium and Peptostreptococci [69e71].…”

Section: Microbiologymentioning

confidence: 99%

Necrotizing skin and soft-tissue infections in the intensive care unit

Peetermans

Prost

Eckmann

et al. 2020

Clinical Microbiology and Infection

103

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Background: Necrotizing skin and soft-tissue infections (NSTI) are rare but potentially life-threatening and disabling infections that often require intensive care unit admission. Objectives: To review all aspects of care for a critically ill individual with NSTI. Sources: Literature search using Medline and Cochrane library, multidisciplinary panel of experts. Content: The initial presentation of a patient with NSTI can be misleading, as features of severe systemic toxicity can obscure sometimes less impressive skin findings. The infection can spread rapidly, and delayed surgery worsens prognosis, hence there is a limited role for additional imaging in the critically ill patient. Also, the utility of clinical scores is contested. Prompt surgery with aggressive debridement of necrotic tissue is required for source control and allows for microbiological sampling. Also, prompt administration of broad-spectrum antimicrobial therapy is warranted, with the addition of clindamycin for its effect on toxin production, both in empirical therapy, and in targeted therapy for monomicrobial group A streptococcal and clostridial NSTI. The role of immunoglobulins and hyperbaric oxygen therapy remains controversial. Implications: Close collaboration between intensive care, surgery, microbiology and infectious diseases, and centralization of care is fundamental in the approach to the severely ill patient with NSTI. As many aspects of management of these rare infections are supported by low-quality data only, multicentre trials are urgently needed.

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“…In mediastinitis secondary to DNM, empirical antimicrobial therapy should cover those aerobic and anaerobic bacteria commonly associated with ear, nose and throat infections. Although there are no standardized regimens described in the academic literature, a third-generation cephalosporin with metronidazole [21] or a combination of piperacillin/tazobactam and clindamycin is suggested [56].…”

Section: Antimicrobial Therapymentioning

confidence: 99%

Mediastinitis in the intensive care unit patient: a narrative review

Pastène

Cassir

Tankel

et al. 2020

Clinical Microbiology and Infection

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Background: Mediastinitis is a rare but severe infection, defined as an inflammation of the connective tissues and structures within the mediastinum. Due to its proximity to vital structures, mediastinitis represents a highly morbid pathological process associated with a high risk of mortality. In most cases mediastinitis requires treatment in the intensive care unit. Objectives: To highlight to the reader the clinical features of mediastinitis, to attempt to define each clinical scenario, to describe the responsible pathogens and finally to depict both the medical and surgical treatments. Sources: We performed a literature search of the PubMed and Cochrane libraries, limited for articles published between January 2003 and December 2018, reporting on acute mediastinitis. Content: The term covers different entities of different aetiologies including deep sternal wound infection related to sternotomy; oesophageal perforation or anastomosis leakage; and finally descending necrotizing mediastinitis, often secondary to oropharyngeal abscess. The responsible pathogens and therefore subsequent management depends on the underlying aetiology. Empirical antimicrobial therapy should cover the suspected microorganisms while surgery and supportive measures should aim to reduce the inoculum of pathogens by providing adequate drainage and debridement. Implications: Literature concerning mediastinitis in the intensive care unit is relatively scarce. We have collated the evidence and reviewed the different causes and treatment options of acute mediastinitis with a particular focus on microbiological epidemiology. Future research in larger cohorts is needed to better understand the treatment of this difficult disease.

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Cervical necrotizing fasciitis: Systematic review and analysis of 1235 reported cases from the literature

Abstract: Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality.

Cited by 100 publications

References 52 publications

Multidisciplinary treatment of deep neck infection associated with descending necrotizing mediastinitis: a single-centre experience

Multidisciplinary treatment of deep neck infection associated with descending necrotizing mediastinitis: a single-centre experience

Necrotizing skin and soft-tissue infections in the intensive care unit

Mediastinitis in the intensive care unit patient: a narrative review

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