Necrotizing Soft Tissue Infection After Intravenous Drug Injection: A Multidisciplinary Approach to Surgical Management at a Community Hospital

Ginting, Karolin; Caparelli, Michael L.; Kundu, Neilendu

doi:10.1177/0003134820933596

Cited by 4 publications

(10 citation statements)

References 4 publications

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“…There were some similar cases reported in the literature on NSTIs after intravenous injection. Ginting et al reported a similar case of upper extremity NSTI in an intravenous drug user after injecting with cocaine mixed with flavored drink mix requiring serial wound debridement and reconstruction [5].…”

Section: Discussionmentioning

confidence: 99%

Necrotizing Soft Tissue Infection of Left Shoulder and Upper Limb Following Intravenous Injection of Non-steroidal Anti-inflammatory Drug

Soh¹

2021

Cureus

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Necrotizing soft tissue infection (NSTI) is a rapidly spreading and fulminant infection that may occur within any layer of skin and soft tissue and may result in sepsis and multiorgan failure. Cases of intravenous injection of drugs causing NSTIs have been reported, especially involving injection of illicit drugs or insulin. NSTI can be due to polymicrobial or monomicrobial infection and infection involving Klebsiella species has been rising, especially in patients with diabetes mellitus. This is a case of an extensive upper limb and shoulder Klebsiella pneumoniae NSTI following an injection of a non-steroidal anti-inflammatory drug in a diabetic patient. NSTI diagnosis is based on history and clinical examination, supplemented with imaging and laboratory investigations. Early recognition, extensive and serial debridement, antibiotics, and wound management are crucial for the better outcome of the disease. This patient underwent emergent debridement with antibiotics coverage, followed by serial debridement and wound care. The wound healed within the stipulated time, with good function of the affected limb following the rehabilitation program.

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Section: Discussionmentioning

confidence: 99%

Necrotizing Soft Tissue Infection of Left Shoulder and Upper Limb Following Intravenous Injection of Non-steroidal Anti-inflammatory Drug

Soh¹

2021

Cureus

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“…NF of the upper extremities is less frequently reported, presenting frequencies varying between 6% and 27%. 3,4,7,[15][16][17][18][19][20] According to Anaya et al, in a large series of 166 patients with established NF, the extremities were the most common site of infection (57.8%), followed by the abdomen and the perineum. 19 In a systematic review by Angeles et al, consisting of 12 studies including 317 limbs, the upper extremity was involved in 32% of the cases.…”

Section: Infectionmentioning

confidence: 99%

“…19 In a systematic review by Angeles et al, consisting of 12 studies including 317 limbs, the upper extremity was involved in 32% of the cases. 20 Nevertheless, NF of the upper extremity is believed to be under-reported and is expected to become more frequent, due to the increasing intravenous drug use. Although NF can affect all age groups, the elderly, and middle-aged people (over 50 years old) are more susceptible to it.…”

Section: Infectionmentioning

confidence: 99%

“…47 Angeles et al in their systematic review consisting of 324 limbs reported 71 deaths, attributing to NF of the extremities a mortality rate of 21,9%. 20 According to Anaya et al, out of 96 patients suffering from NF of the extremities, 21 deceased (mortality rate 21,9%) and 25 lost a limb (amputation rate 26%), while Ogilvie et al found that the mortality rate of NF of the extremities was only 9,3% (14 deaths among 150 cases). 19,48 As far as NF of the upper extremity is concerned, retrospective studies report mortality rates of 10% to 36%, while rates of amputation range from 11% to 38%.…”

Section: Mortality and Amputation Ratesmentioning

confidence: 99%

“…About twothirds of these cases concern the lower extremities, while NF of the upper limb is less common, being involved in approximately 6% -27% of the patients. 3,4,7,[15][16][17][18][19][20] Because of its rarity, few studies assess upper limb NF, with most of them being limited to case reports, small case series, series of mixed anatomic sites, or big national database studies with an absence of extensive details relating to certain parameters of upper extremity NF.…”

Section: Introductionmentioning

confidence: 99%

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Necrotizing Fasciitis of the Upper Extremity – A Review

Δίτσιος

Chitas

Christidis³

et al. 2022

Orthopedic Reviews

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Necrotizing fasciitis is a soft tissue infection that habitually originates from the fascial sheaths, expands at a volant pace, leads to extensive necrosis of the subcutaneous tissues, and eventually ends up in a life-threatening condition with notably elevated amputation and mortality rates. Factors that induce interruption of skin integrity, such as trauma or intravenous drug use, are the most common inciting events. Specific clinical signs heralding its presence are usually absent in the early stages, often resulting in misdiagnosis. Early recognition, prompt and aggressive surgical debridement, antibiotic use, and supportive care constitute the fundamental principles to lean on for a better prognosis. Necrotizing fasciitis of the upper extremity is relatively rare and consequently holds a limited place in the literature. Only a few studies assess it as a separate entity, with most of them being case reports or small case series. We, therefore, performed a review of the current literature, to assemble the dispersed results of different studies and clarify the various aspects of upper limb necrotizing fasciitis. In this systematic review, we present the epidemiological data, the causative events, the most frequent underlying diseases, the risk factors, the amputation and mortality rates, the pathogenic microorganisms, the clinical characteristics, the diagnostic tools, the medical and surgical management concerning necrotizing fasciitis of the upper limb. Finally, the results indicating its differentiation compared to necrotizing fasciitis of other anatomic sites are remarkably highlighted.

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First case of subcutaneous cystic phaeohyphomycosis due to Phialophora chinensis in a kidney transplant recipient in Martinique

Pruvot

Messagier

García-Hermoso

et al. 2023

Medical Mycology Case Reports

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Necrotizing Soft Tissue Infection After Intravenous Drug Injection: A Multidisciplinary Approach to Surgical Management at a Community Hospital

Cited by 4 publications

References 4 publications

Necrotizing Soft Tissue Infection of Left Shoulder and Upper Limb Following Intravenous Injection of Non-steroidal Anti-inflammatory Drug

Necrotizing Soft Tissue Infection of Left Shoulder and Upper Limb Following Intravenous Injection of Non-steroidal Anti-inflammatory Drug

Necrotizing Fasciitis of the Upper Extremity – A Review

First case of subcutaneous cystic phaeohyphomycosis due to Phialophora chinensis in a kidney transplant recipient in Martinique

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