Necrotizing fasciitis: is the bacterial spectrum changing?

Tsitsilonis, Serafeim; Druschel, Claudia; Wichlas, Florian; Haas, Norbert; Schwabe, Philipp; Bail, Hermann-Josef; Schaser, Klaus‐Dieter

doi:10.1007/s00423-012-0983-z

Cited by 34 publications

(27 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ultrasonography (US) is considered to be of limited value in the diagnosis of retroperitoneal fasciitis. US may be used to identify focal fluid collections or abscess formation but is unlikely to be able to provide early diagnosis or appropriate staging of the extent of the disease (30,41,42). US has been found to be useful in the evaluation of integument necrotizing fasciitis, in looking for subcutaneous edema, fascial thickening, and fluid collections, particularly in the pediatric population (42).…”

Section: Imaging Featuresmentioning

confidence: 98%

See 1 more Smart Citation

Retroperitoneal Fasciitis: Spectrum of CT Findings in the Abdomen and Pelvis

et al. 2015

View full text Add to dashboard Cite

Retroperitoneal fasciitis is a rare but potentially lethal complication of infection. Early diagnosis is crucial and is usually made when there is a high degree of clinical suspicion combined with characteristic imaging findings leading to early surgical intervention. Computed tomography (CT) can play a central role in demonstrating early findings, assessing the extent of disease to help determine the best surgical approach, identifying the primary source of infection, and evaluating the treatment response. The possible presence of retroperitoneal fasciitis should be considered in patients presenting with symptoms of sepsis, including pain that is disproportionate with the clinical abnormality. When retroperitoneal fasciitis is suspected, emergency CT can facilitate early diagnosis and evaluation of the extent of disease. Common findings at CT include fascial thickening and enhancement, muscular edema, fat stranding, fluid collections, and abscess formation. Gas tracking along fascial planes in the retroperitoneum is the hallmark of retroperitoneal fasciitis but is not seen in all cases. Another important clue to the diagnosis is asymmetric involvement of the retroperitoneal fascial planes and deep tissues. Fasciitis in the retroperitoneum may originate from infected retroperitoneal organs or from infection that spreads along indirect and/or direct pathways from a primary source elsewhere in the body. Findings of indirect tracking and transgression of fascial planes may indicate more severe infection associated with the necrotizing form of retroperitoneal fasciitis. Despite aggressive antibiotic treatment, early and repeated surgical débridement may be required to remove nonviable tissue in patients with the necrotizing form of retroperitoneal fasciitis. Awareness of the anatomy of the retroperitoneum, potential routes of spread of infection, and the spectrum of CT findings in retroperitoneal fasciitis is needed to achieve prompt diagnosis and guide treatment.

show abstract

Section: Imaging Featuresmentioning

confidence: 98%

“…Not surprisingly, the most common causative agent of necrotizing fasciitis in the extremities is bhemolytic group A Streptococcus (2,7), followed by methicillin-resistant S aureus (30).…”

Section: Teaching Pointsmentioning

confidence: 99%

Retroperitoneal Fasciitis: Spectrum of CT Findings in the Abdomen and Pelvis

et al. 2015

View full text Add to dashboard Cite

show abstract

“…One researcher, noting mutually contradictory results among series of investigations similar in scale to our own, cites the diversity of populations and variables studied as well as small sample sizes as explanatory of such divergent results [16]. Globally, the datum with the least predictive power for mortality seems to be whether an infection is monomicrobial or polymicrobial, with particularly broad variability across the literature [34,35] and even reports of a shift in prevalence from one microbial type to the other within a single study of NSTIs [36]. Therefore, it may even be useful to reframe the term ''locale'' so as to distinguish not only separate geographical regions but also multiple investigations of a single region separated significantly in time.…”

Section: Microbiologic Considerationsmentioning

confidence: 99%

The Prediction Predicament: Rethinking Necrotizing Soft Tissue Infections Mortality

Moore

Levy

Prematilake

2015

Surgical Infections

View full text Add to dashboard Cite

Background: Our study sought to identify independent risk factors predisposing patients with necrotizing soft tissue infections (NSTIs) to mortality from among laboratory values, demographic data, and microbiologic findings in a small population. To this end, a retrospective review was conducted of the medical records of all patients with NSTI who had been treated at our institution from 2003 to 2012 (n = 134). Methods: Baseline demographics and comorbidities, clinical and laboratory values, hospital course, and the microbiologic characteristics of surgical incision cultures were recorded. Each variable was tested for association with survival status and all associated variables with p < 0.15 were included in a logistic regression model to seek factors associated independently with mortality. Results: Surprisingly, no demographic or pre-existing condition proved to be a predictor of mortality. Two laboratory values had an inverse correlation to mortality: High C-reactive protein (CRP) and highest recorded CRP. Of surgical incisions that grew bacteria in culture, 33.6% were polymicrobial. Mortality rates were highest with Enterococcus-containing polymicrobial infections (50%), followed by those containing Pseudomonas (40%), and Streptococcus spp. (27%). Understanding why so many studies across the literature, now including our own, find such disparate results for correlation of NSTI mortality with patient data may lie in the fundamentally dynamic nature of the organisms involved. Conclusions: This study suggests that no single factor present on admission is a robust predictor of outcome; it is likely that survival in NSTI is predicated upon a complex interaction of multiple host and microbial factors that do not lend themselves to reduction into a simple formula. It is also abundantly clear that the wellestablished principles of NSTI surgery should continue to be followed in all cases, with an emphasis on early debridement, irrespective of apparent severity of initial presentation.

show abstract

“…Given the mechanisms of action it is reasonable to assume IVIG have a role in the treatment of patients with staphylococcal TSS. With the rising incidence of MRSA related infections [1,6,11,24] the role of IVIG might turn out to be even more important in controlling these infections.…”

Section: Resultsmentioning

confidence: 99%

Toxic shock syndrome toxin-I producing Staphylococcus aureus in fulminant necrotizing fasciitis

Verweij¹,

Kolwijck²,

Pompe³

2016

Clin Case Rep Rev

View full text Add to dashboard Cite

A 67-year old man was admitted to our Intensive Care Unit (ICU) with septic shock. Five days earlier he presented to the Emergency Department with a mild fever (up to 38 degrees Celsius) and paravertebral back pain. An abdominal ultrasound revealed no pathologic findings (no abdominal aneurysm, gall stones or pancreatitis). His symptoms were attributed to muscular pain possibly caused by influenza (endemic at the time) and he was discharged.Over the course of 5 days he deteriorated, with severe and progressive back pain with radiation to both legs (which caused an inability to walk) and high fever (up to 41 degrees Celsius). On examination he was tachycardic (heart rate 130 bpm), hypotensive (initial systolic BP 70 mmHg, 99 mmHg after 3 L fluid resuscitation). He was alert with a respiratory rate of 20/min and oxygen saturation of 97% on 4 L O 2 /min. Abnormalities on physical examination included basal crepitations, a small pustulous skin lesion on his right upper abdomen and cold extremities with mottled blue skin; no other skin lesions were present, nor were any cardiac murmurs present. Examination of his legs showed no sensory or motor deficits, normal peripheral arterial pulsations and soft, non-tender calves. Laboratory results showed a slight leucopenia (3.8 × 10 9 /L), thrombocytopenia (59 × 10 9 /L), C-reactive protein 360 mg/L, creatinine 280 µmol/L and lactate 5.4 mmol/L. Blood cultures were drawn, the patient received antibiotics (ceftriaxone 2000 mg according to local protocol) and was admitted to the ICU for further treatment. On repeated examination he developed a discolouration of the skin on the dorsal side of his left thigh extending to just below the knee. It was blue/purple with surrounding erythema and mildly tender on palpation. A CT-scan was performed, showing induration of skin and subcutaneous tissue in the left thigh. No abdominal or retroperitoneal pathology was detected. Because necrotizing fasciitis was suspected, the patient was started on penicillin, clindamycin, gentamicin, intravenous immunoglobulins (IVIG) and underwent emergency surgical exploration. The subcutaneous tissue and fascia were swollen and excisional biopsies showed extensive presence of gram positive cocci. The diagnosis of necrotizing fasciitis was confirmed. Extensive surgical debridement of skin, subcutaneous tissue and muscle fascia of the dorsum of the left upper leg was performed. The patient developed severe septic shock with multi-organ failure and required high dose norepinephrine, vasopressin and steroid treatment. His condition slightly improved after surgery, antibiotics and IVIG administration. However, soon after the initial stabilisation he developed new skin lesions on his right leg for which he underwent a second surgical procedure. During surgery, similar findings to those in the left leg necessitated another debridement. Upon return to the ICU his condition had deteriorated further, with persistent anuria, severe metabolic acidosis with lactate levels of more than 15 mmol/L and cardiac failure. A...

show abstract

Necrotizing fasciitis: is the bacterial spectrum changing?

Abstract: The present study suggests a shift of the bacterial spectrum towards monomicrobial infections with multiresistant bacteria. The early recognition of high-risk patients and the aggressive surgical treatment with at least double-schema antibiotic therapy are of outmost importance.

Cited by 34 publications

References 27 publications

Retroperitoneal Fasciitis: Spectrum of CT Findings in the Abdomen and Pelvis

Retroperitoneal Fasciitis: Spectrum of CT Findings in the Abdomen and Pelvis

The Prediction Predicament: Rethinking Necrotizing Soft Tissue Infections Mortality

Toxic shock syndrome toxin-I producing Staphylococcus aureus in fulminant necrotizing fasciitis

Contact Info

Product

Resources

About