Interventions for necrotizing soft tissue infections in adults

Abstract

We found very little evidence on the effects of medical and surgical treatments for NSTI. We cannot draw conclusions regarding the relative effects of any of the interventions on 30-day mortality or serious adverse events due to the very low quality of the evidence.The quality of the evidence is limited by the very small number of trials, the small sample sizes, and the risks of bias in the included trials. It is important for future trials to clearly define their inclusion criteria, which will help with the applicability of future trial results to a real-life population.Management of NSTI participants (critically-ill participants) is complex, involving multiple interventions; thus, observational studies and prospective registries might be a better foundation for future research, which should assess empiric antimicrobial therapy, as well as surgical debridement, along with the placebo-controlled comparison of adjuvant therapy. Key outcomes to assess include mortality (in the acute phase of the condition) and long-term functional outcomes, e.g. quality of life (in the chronic phase).

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

“…Case reports were excluded, as were articles that did not involve critically ill patients with NSTI. We also searched the reference lists of relevant recent review articles [17,18].…”

“…There are no randomized clinical trials on empirical antimicrobial therapy in NSTI available, and data on optimal antibiotic treatment in NSTI are scarce [18]. Contemporary guidelines and recommendations offer pragmatic approaches as they are based on observational studies, experience in treatment of less severe infections, as well as experimental data.…”

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

“…Recently, a Cochrane review on intervention for NSTIs was published [110]. One trial of 100 randomized participants assessed IVIG as an adjuvant drug, given at a dose of 25 g/day, compared with placebo, given for three consecutive days.…”

Impact of a multidisciplinary care bundle for necrotizing skin and soft tissue infections: a retrospective cohort study

“…Even when diagnostic issues have been overcome, further delays can occur because of logistical and technical difficulties regarding operating room emergency access [7]. Management in high case volume centers has been associated with enhanced survival [8], while a recent Cochrane review highlighted the lack of high quality evidence for a benefit on mortality for any single intervention [9]. This implies the need for a multimodal approach of NSTIs, as coordination of multiple urgent interventions has led to improved outcomes in other settings [10–13].…”