Differentiation of necrotizing fasciitis and cellulitis using MR imaging.

Schmid, Marius R.; Kossmann, Thomas; Duewell, Stefan

doi:10.2214/ajr.170.3.9490940

Cited by 326 publications

(183 citation statements)

References 21 publications

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“…14,25 Although magnetic resonance imaging has been proposed to differentiate NSTIs from nonNSTIs, its high sensitivity and low specificity can result in overdiagnoses of NSTIs that may lead to unnecessary surgery. 26,27 Causative Pathogens Certain pathogens are associated with specific types of infections and should be considered along with patient characteristics and predisposing risk factors. Streptococcus species and S aureus Not included in Infectious Diseases Society of America guidelines.…”

Section: Imagingmentioning

confidence: 99%

Hospitalist Perspective on the Treatment of Skin and Soft Tissue Infections

Amin

Cerceo

Deitelzweig

et al. 2014

Mayo Clinic Proceedings

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The prevalence of skin and soft tissue infections (SSTIs) has been increasing in the United States. These infections are associated with an increase in hospital admissions. Hospitalists play an increasingly important role in the management of these infections and need to use hospital resources efficiently and effectively. When available, observation units are useful for treating low-risk patients who do not require hospital admission. Imaging tools may help to exclude abscesses and necrotizing soft tissue infections; however, surgical exploration remains the principal means of diagnosing necrotizing soft tissue infections. The most common pathogens that cause SSTIs are streptococci and Staphylococcus aureus. Methicillin-resistant S aureus (MRSA) is a prevalent pathogen, and concerns are increasing regarding the unclear distinctions between community-acquired and hospital-acquired MRSA. Other less frequent pathogens that cause SSTIs include Enterococcus species, Escherichia coli, Klebsiella species, Enterobacter species, and Pseudomonas aeruginosa. Cephalexin and clindamycin are suitable options for infections caused by streptococcal species and methicillin-susceptible S aureus. The increasing resistance of S aureus and Streptococcus pyogenes to erythromycin limits its use in these infections, and better alternatives are available. Parenteral cefazolin, nafcillin, or oxacillin can be used in hospitalized patients with nonpurulent cellulitis caused by streptococci and methicillin-susceptible S aureus. When oral MRSA therapy is indicated, clindamycin, doxycycline, trimethoprim-sulfamethoxazole, or linezolid is appropriate. Vancomycin, linezolid, daptomycin, tigecycline, telavancin, and ceftaroline fosamil are intravenous options that should be used in MRSA infections that require patient hospitalization. In the treatment of patients with SSTIs, hospitalists are at the forefront of providing proper patient care that reduces hospital costs, duration of therapy, and therapeutic failures. This review updates guidelines on the management of SSTIs with a focus on infections caused by S aureus, particularly MRSA, and outlines the role of the hospitalist in the effective management of SSTIs.

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Section: Imagingmentioning

confidence: 99%

Hospitalist Perspective on the Treatment of Skin and Soft Tissue Infections

Amin

Cerceo

Deitelzweig

et al. 2014

Mayo Clinic Proceedings

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“…6 Imaging modalities such as computed tomography, magnetic resonance imaging and frozen section biopsy have been previously used in the discrimination between necrotising fasciitis and other soft tissue infections but these methods have been limited by cost and availability. 2,7,8 The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) is a clinical tool first described by Wong C et al 9 The tool is based on six common serum parameters at the time of presentation: C-reactive protein (CRP), total white cell count, haemoglobin, serum sodium, creatinine and glucose (Table 1). An LRINEC of six or greater confers a higher risk of necrotising fasciitis.…”

Section: Introductionmentioning

confidence: 99%

Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature

Bechar

Sepehripour

Hardwicke

et al. 2017

annals

155

106

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INTRODUCTION Early operative debridement of necrotising fasciitis is a major outcome determinant. Identification and diagnosis of such patients can be clinically difficult. The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score first published in 2004 is based on routinely performed parameters and offers a method for identifying early cases. No literature review has yet been performed on the application of such a score. METHODS A systematic review of English-language literature was performed from 2004 to 2014 to identify articles reporting use of LRINEC score and the incidence of necrotising fasciitis. We performed a critical review of PubMed, Medline and Embase in line with the PRISMA statement. A meta-analysis was performed with a random effects model and 95% confidence interval. Suitable correlation coefficient and receiver operating characteristic (ROC) curves were also calculated. RESULTS After application of inclusion criteria, 16 studies with 846 patients were included. The mean LRINEC score in patients with necrotising fasciitis was 6.06. Two papers reported LRINEC score in patients without necrotising fasciitis with a mean 2.45. All six studies with a reported coefficient of variance were < 1; Pearson correlation coefficient was r = 0.637 (P = 0.011). An ROC curve showed an area under the curve of 0.927. CONCLUSIONS The LRINEC score is a useful clinical determinant in the diagnosis and surgical treatment of patients with necrotising fasciitis, with a statistically positive correlation between LRINEC score and a true diagnosis of necrotising fasciitis.

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“…However, the presence of marked systemic toxicity out of proportion to the local findings should alert the physician. CT scanning and magnetic resonance imaging (MRI) can demonstrate subcutaneous and fascial edema, as well as tissue gas, in patients with NF and distinguish this process from cellulitis [50].Early treatment is often presumptive, thus, antibiotics should be started as soon as this condition (NF) is suspected. Initial treatment often includes a combination of intravenous antibiotics including piperacillin/tazobactam, vancomycin, andclindamycin or broad spectrum antibiotics which include ampicillin-sulbactam combined withmetronidazole,clindamycin or carbapenems(imipenem) [51] Cultures are taken to determine appropriate antibiotic coverage and antibiotics may be changed when culture results are obtained.…”

Section: Managementmentioning

confidence: 99%

Necrotizing Fasciitis: Current Concepts, Pathogensand Management

Mustafa¹,

Firdaus²,

Elllzam³

et al. 2017

IOSR JDMS

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Abstract:Necrotizing fasciitis (NF) is a severe disease of sudden onset that spreads rapidly. The disease is more common in the adults Medical imaging is helpful to confirm diagnosis. Initial treatment includes a combination of intravenous antibiotics including piperacillin/tazobactam, vancomycin, and clindamycin or ampicillinsulbactam combined with metronidazole, clindamycin or carbapenems(imipenem).Aggressive surgical debridement is always necessary. Amputation of infected limb(s) may be necessary. Ancillary therapies, neither a substitute for surgical debridement nor proven efficacy have been described. Some studies recommend using intravenous immunoglobulin (IVIG).Nutritional support is imperative. High mortality rates if left untreated. High index of suspicion and knowledge is essential for early diagnosis and outcomes of NF.

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Differentiation of necrotizing fasciitis and cellulitis using MR imaging.

Abstract: This study was performed to evaluate the diagnostic value of MR iii aging in differentiating necrotizing fasciitis from cellulitis. MATERIALS AND METHODS.

Cited by 326 publications

References 21 publications

Hospitalist Perspective on the Treatment of Skin and Soft Tissue Infections

Hospitalist Perspective on the Treatment of Skin and Soft Tissue Infections

Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature

Necrotizing Fasciitis: Current Concepts, Pathogensand Management

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