Differentiating Upper Extremity Necrotizing Soft Tissue Infection From Serious Cellulitis and Abscess

Abstract

IntroductionNecrotizing soft tissue infection (NSTI) of the upper extremity (UE) is a rapidly progressing infection that requires early diagnosis and emergent treatment to decrease risks of loss of limb or life. Clinical presentation, particularly of early NSTI, can appear similar to serious cellulitis or abscess. The purpose of this study was to identify factors that are associated with NSTI rather than serious cellulitis and abscess to differentiate patients with similar clinical presentations. MethodsThis study uses a retrospective cohort design that compares patients ultimately diagnosed with UE NSTI versus those diagnosed with UE serious cellulitis or abscess. Cohorts were matched using the Laboratory Risk Indicators for Necrotizing Fasciitis (LRINEC) score in the setting of UE soft tissue infection. Laboratory values, vital signs, subjective symptoms, and social factors including substance abuse and domiciled status were recorded. Continuous variables were compared using the Mann-Whitney U test, whereas categorical variables were compared using the chi-squared test or the Fisher exact test (for expected values less than 5). A binary logistic regression for continuous and categorical variables was also performed. Significance was set at p<0.05. Univariate and multivariate analyses were performed. ResultsMultivariate statistical analysis and clinical interpretation of data identified four factors more associated with a diagnosis of NSTI than serious cellulitis or abscess: elevated lactate on hospital presentation, a patient-reported history of fever, male gender, and homelessness. ConclusionsIn patients with upper extremity infections, the clinical presentation of NSTI and serious cellulitis or abscess may appear similar. In this retrospective cohort of patients matched with LRINEC scores, elevated lactate, subjective fever, male gender, and homelessness were significantly associated with NSTI rather than serious cellulitis or abscess.

Infections of the extremities as a complications of the intravenous use of psychoactive substances

“…In the literature, there is still a lack of papers about all aspects of infection complication treatment in the population of drug addicts. Surgical treatment is essential in infection complication healing and healing of skin and soft tissue defects 8,[12][13][14] . In professional psychiatric and surgical literature, there are very few papers about surgical procedures in the treatment of infection complications among drug addicts.…”

Rational Use of Ceftriaxone in Necrotizing Fasciitis and Mortality Associated with Bloodstream Infection and Hemorrhagic Bullous Lesions

“…Hemorrhagic bullae is a special skin sign that can be crucial for identifying and recognizing necrotizing fasciitis; moreover, it can even be the cause of devastating consequences [ 5 , 6 , 7 , 8 , 9 ]. The early recognition and diagnosis of NF using skin bullous lesions, purple skin discoloration, hypotension, and elevated laboratory markers can allow for the initiation of proper treatment strategies to decrease mortality rates [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ].…”