Necrotizing soft tissue infections after injection therapy: Higher mortality and worse outcome compared to other entry mechanisms

Friederichs, Jan; Torka, Sebastian; Militz, M.; Bühren, V.; Hungerer, Sven

doi:10.1016/j.jinf.2015.05.013

Cited by 11 publications

(9 citation statements)

References 25 publications

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“…The same study showed that S. pyogenes was the third most frequently detected gram-positive aerobe, following Staphylococcus aureus and viridans streptococci. Another study revealed that patients with a necrotizing fasciitis after injection or infiltration therapy have a poor prognosis in terms of survival and amputation rate [11]. In our case, redness and swelling spread from peripheral infusion cannulation sites on both forearms.…”

Section: Discussionmentioning

confidence: 52%

“…However, in the 50% of patients who develop necrotizing fasciitis without a defined portal of entry, the infection begins deep in the tissues, frequently at the site of a hematoma, muscle strain, or traumatic joint injury [1]. There are some studies of necrotizing fasciitis associated with drug injection [10,11]. One study found that 54% of drug users with necrotizing fasciitis developed the infection at an injection site [10].…”

Section: Discussionmentioning

confidence: 99%

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Necrotizing fasciitis following primary peritonitis caused by Streptococcus pyogenes with covS mutation in a healthy woman: a case report

et al. 2019

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Background: Primary peritonitis due to Streptococcus pyogenes (S. pyogenes) is uncommon in patients without comorbid conditions such as immunosuppression, nephritic disease, or liver cirrhosis. Furthermore, it does not cause another infection at the same time in a healthy person. However, several S. pyogenes mutants have been reported, and some of them exhibit strong virulence. Mutation of the control of virulence (cov) S gene of Streptococcus enhances bacterium survival by repressing negative regulators of virulence, which causes bacterial invasion of aseptic tissues, such as the parenteral space. We report a case of primary peritonitis and subsequent necrotizing fasciitis by the same S. pyogenes species with mutated covS in a previously healthy woman. Case presentation: We present the case of a 55-year-old woman admitted to the hospital due to abdominal pain and nausea. She was treated for peritonitis. A few days later, she became hypotensive and tachycardic and was transferred to the intensive care unit (ICU) for the treatment of septic shock with primary peritonitis. On the second day of her ICU stay, both of her forearms developed swelling and redness around the peripheral injection site. The patient had developed necrotizing fasciitis. Since her skin symptoms spread rapidly, urgent debridement was performed. Her condition improved with antibiotic treatment and multiple episodes of debridement. S. pyogenes was detected in cultures of the patient's blood, ascites, and skin. The identified strain was emm89 genotype and had a genetic mutation of covS. Conclusions: S. pyogenes with covS mutation may spread from a portal, such as the upper respiratory tract or digestive system, to all organs immediately, causing septic shock. Infection with S. pyogenes with mutated genes should be considered in the differential diagnosis of gastrointestinal symptoms, even in a previously healthy patient.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Necrotizing fasciitis following primary peritonitis caused by Streptococcus pyogenes with covS mutation in a healthy woman: a case report

et al. 2019

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“…From the review of literature, only 19 cases of NSTIs after intramuscular injections have been reported. All these are case reports except one [ 1 ], in which the authors describe 10 cases of NSTIs after intramuscular injection observed over a period of 10 years; otherwise, it is hard to extract patients' data because the revision includes also cases of NSTIs after infiltrations.…”

Section: Discussionmentioning

confidence: 99%

“…Several small studies and cases reports have been published describing fulminant NSTIs after injection. Only a case study of 10 patients with NSTIs after intramuscular injections has been reported in a recent work [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Necrotizing Soft Tissue Fasciitis after Intramuscular Injection

Abbate

Almasio

Mongitore

et al. 2018

Case Reports in Surgery

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Necrotizing soft tissue fasciitis (NSTIs) or necrotizing fasciitis is an infrequent and serious infection. Herein, we describe the clinical course of a female patient who received a diagnosis of NSTIs after gluteus intramuscular injection. We also report the results of our review of published papers from 1997 to 2017. Since now, 19 cases of NSTIs following intramuscular injections have been described. We focus on the correlation between intramuscular injection and NSTIs onset, especially in immunosuppressed patients treated with corticosteroids, suffering from chronic diseases or drug addicted. Intramuscular injections can provoke severe tissue trauma, representing local portal of infection, even if correctly administrated. Otherwise, it is important not to inject drug in subcutaneous, which is a less vascularized area and therefore more susceptible to infections. Likewise, a proper injecting technique and aspiration prior to injection seem to be valid measure to prevent intra-arterial or para-arterial drug injection with the consequent massive inflammatory reaction. Necrosis at the infection site appears to be independent of the drug, and it is a strong additional risk factor for NSTIs.

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“…Necrotising soft-tissue infections are rare, but severe, infections associated with high morbidity and mortality 1. Treatment should be aggressive, both surgical and antibiotic, and the outcome depends on the location, micro-organisms involved and patients’ prognostic factors, such as diabetes, immunosuppression, drug abuse and age.…”

Section: Descriptionmentioning

confidence: 99%

Gas-forming gluteal abscess after intramuscular self-injections due toClostridium perfringens

et al. 2019

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Necrotizing soft tissue infections after injection therapy: Higher mortality and worse outcome compared to other entry mechanisms

Cited by 11 publications

References 25 publications

Necrotizing fasciitis following primary peritonitis caused by Streptococcus pyogenes with covS mutation in a healthy woman: a case report

Necrotizing fasciitis following primary peritonitis caused by Streptococcus pyogenes with covS mutation in a healthy woman: a case report

Necrotizing Soft Tissue Fasciitis after Intramuscular Injection

Gas-forming gluteal abscess after intramuscular self-injections due toClostridium perfringens

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