Impact of timing of surgery on outcome of Vibrio vulnificus–related necrotizing fasciitis

Chao, Wai-Nang; Tsai, Chin‐Feng; Chang, Horng-Rong; Chan, Khee‐Siang; Su, Ching‐Tzong; Lee, Yuan‐Ti; Ueng, Kwo‐Chang; Chen, Chun‐Chieh; Chen, Shiuan‐Chih; Lee, Meng-Chih

doi:10.1016/j.amjsurg.2012.08.008

Cited by 96 publications

(53 citation statements)

References 38 publications

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“…Early surgery (within 12 h after admission) has been shown to improve survival substantially [20]. Redebridement is also a necessary step in the surgical care of NSTI patients.…”

Section: Discussionmentioning

confidence: 99%

Tigecycline in the Treatment of Patients with Necrotizing Skin and Soft Tissue Infections Due to Multiresistant Bacteria

EckmannChristian

HeizmannWolfgang²,

BodmannKlaus-Friedrich³

et al. 2015

Surgical Infections

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“…Early surgery (within 12 h after admission) has been shown to improve survival substantially [20]. Redebridement is also a necessary step in the surgical care of NSTI patients.…”

Section: Discussionmentioning

confidence: 99%

Tigecycline in the Treatment of Patients with Necrotizing Skin and Soft Tissue Infections Due to Multiresistant Bacteria

EckmannChristian

HeizmannWolfgang²,

BodmannKlaus-Friedrich³

et al. 2015

Surgical Infections

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“…In 1951 Wilson proposed the term "necrotizing fasciitis" for all difficult forms of soft tissue infection with superficial fascia necrosis 7,8 . Nowadays, as was usually in the past time, the diagnosis of NF is often delayed because the symptoms mimic some of similar conditions in the early stage of the disease [9][10][11] . If physicians miss the diagnosis in the early course of the disease, morbidity and mortality rate is high.…”

Section: Introductionmentioning

confidence: 99%

“…If physicians miss the diagnosis in the early course of the disease, morbidity and mortality rate is high. Immediate and aggressive excision of the affected tissue is recommended after the diagnosis [10][11][12] . The cornerstone of surgical treatment is excision of all the affected tissues and repeating the same procedure every day until the newly infected tissue removal.…”

Section: Introductionmentioning

confidence: 99%

“…That leads to long hospital stay, repeated surgical excisions, residual deformity and a high rate of mortality. The final outcome of the treatment of those with acute NF depends mainly on the prompt and aggressive surgical treatment [9][10][11]14 . For all patients presented with acute infection, differentiation between other soft tissue infection and acute NF is a matter of great importance.…”

Section: Introductionmentioning

confidence: 99%

“…A full thickness skin and affected tissue biopsy and taking swabs for bacteriological examination are required 5,7,11,13 . Frozen section biopsy of the affected tissue, as a histological technique is useful in differential diagnosis NF and could be life-saving procedure in patients with lack of specific skin signs of this difficult disease.…”

Section: Introductionmentioning

confidence: 99%

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A 5-year retrospective analysis of Necrotizing fasciitis: A single center experiences

et al. 2015

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Acute NF is a rare but very difficult and sometimes life-threatening disease of superficial fascia and around soft tissue. If acute NF is suspected, early radical excision of all the affected tissue with exploration and excision of superficial fascia with pathological and microbiological assessment are most significant for treatment. Appropriate antibiotics and intensive care set ting to manage other organ failure of NF are recommended at the same time with surgery.

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Association Between Time to Source Control in Sepsis and 90-Day Mortality

Reitz

Kennedy

et al. 2022

JAMA Surg

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IMPORTANCE Rapid source control is recommended to improve patient outcomes in sepsis. Yet there are few data to guide how rapidly source control is required.OBJECTIVE To determine the association between time to source control and patient outcomes in community-acquired sepsis.DESIGN, SETTING, AND PARTICPANTS Multihospital integrated health care system cohort study of hospitalized adults (January 1, 2013, to December 31, 2017) with community-acquired sepsis as defined by Sepsis-3 who underwent source control procedures. Follow-up continued through January 1, 2019, and data analyses were completed March 17, 2022.EXPOSURES Early (<6 hours) compared with late (6-36 hours) source control as well as each hour of source control delay (1-36 hours) from sepsis onset.MAIN OUTCOMES AND MEASURES Multivariable models were clustered at the level of hospital with adjustment for patient factors, sepsis severity, resource availability, and the physiologic stress of procedures generating adjusted odds ratios (aOR) and 95% CI. RESULTSOf 4962 patients with sepsis (mean [SD] age, 62 [16] years; 52% male; 85% White; mean [SD] Sequential Organ Failure Assessment score, 3.8 [2.5]), source control occurred at a median (IQR) of 15.4 hours (5.5-21.7) after sepsis onset, with 1315 patients (27%) undergoing source control within 6 hours. The crude 90-day mortality was similar for early and late source control (n = 177 [14%] vs n = 529 [15%]; P = .35). In multivariable models, early source control was associated with decreased risk-adjusted odds of 90-day mortality (aOR, 0.71; 95% CI, 0.63-0.80). This association was greater among gastrointestinal and abdominal (aOR, 0.56; 95% CI, 0.43-0.80) and soft tissue interventions (aOR, 0.72; 95% CI, 0.55-0.95) compared with orthopedic and cranial interventions (aOR, 1.33; 95% CI, 0.96-1.83; P < .001 for interaction).CONCLUSIONS AND RELEVANCE Source control within 6 hours of community-acquired sepsis onset was associated with a reduced risk-adjusted odds of 90-day mortality. Prioritizing the rapid identification of septic foci and initiation of source control interventions can reduce the number of avoidable deaths among patients with sepsis.

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Impact of timing of surgery on outcome of Vibrio vulnificus–related necrotizing fasciitis

Cited by 96 publications

References 38 publications

Tigecycline in the Treatment of Patients with Necrotizing Skin and Soft Tissue Infections Due to Multiresistant Bacteria

Tigecycline in the Treatment of Patients with Necrotizing Skin and Soft Tissue Infections Due to Multiresistant Bacteria

A 5-year retrospective analysis of Necrotizing fasciitis: A single center experiences

Association Between Time to Source Control in Sepsis and 90-Day Mortality

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