Necrotizing Soft-tissue Infections: An Orthopaedic Emergency

Abstract

Necrotizing soft-tissue infections are caused by a variety of bacterial pathogens that may affect patients at any age or health status. This orthopaedic emergency initially presents with nonspecific signs such as erythema and edema. As the disease progresses, classic signs such as bullae, cutaneous anesthesia, ecchymosis, tense edema, and gas can be seen. A high level of suspicion is needed to properly identify and treat in a timely manner. Pain out of proportion to presentation and rapid progression even with appropriate antibiotic treatment should heighten suspicion of a necrotizing soft-tissue infection. The mainstay of management is extensive débridement and decompression of all necrotic tissue and broad-spectrum antibiotics. Débridements are repeated to ensure that disease progression has been halted. Early surgical débridements should take precedent over transfer because of the high rate of limb loss and mortality as a result of surgical delay.

Refractory Buttock Pain: A Possible Sign of Severe Soft Tissue Infection

“…A precise, prompt diagnosis and appropriate treatment are key to the patient's survival in cases of severe tissue soft infection. [4] As the present patient had been prescribed duloxetine before her symptoms started, which had controlled her pain, this drug might have increased her pain threshold, potentially resulting in a delayed diagnosis. In order to correctly diagnose the condition, it is important for physicians to be aware of its possibility when patients present with severe pain-irrespective of whether or not the skin looks like intact, the patient has unstable vital signs, or an abrupt deterioration of a skin lesion is noted-and perform appropriate examinations, including blood culture, a biochemical analysis, computed tomography or magnetic resonance imaging, and surgical exploration of the affected lesion.…”

Patients with Monomicrobial Aeromonas Necrotizing Fasciitis Had Higher Mortality Rates Than Those of Vibrio vulnificus Infections

“…Monomicrobial gram-negative necrotizing fasciitis had been reported to have more fulminant clinical cources and higher motality than gram-positive necrotizing fasciitis in the past decade (4)(5)(6)(7)(8)(9)(10)(11). Vibrio vulnificus, Aeromonas hydrophila, and Klebsiella pneumoniae were the most frequently reported gram-negative aerobic pathogens of necrotizing fasciitis in southwest Taiwan (4, 8, 10-21).…”

“…Necrotizing fasciitis which is a rapidly progressive, life-threatening soft-tissue infection with an average of mortality rate of 22.6 to 33% has been documented a medical and orthopaedic emergency in the past decade (1)(2)(3)(4)(5)(6). Necrotizing fasciitis needs early diagnosis, emergent surgical debridement, and broad-spectrum antibiotic therapy when patients appear in the emergency department (1)(2)(3)(4)(5).…”

“…Although type I necrotizing fasciitis which is a polymicrobial infection involving aerobic and anaerobic organisms was often reported, the incidence of monomicrobial necrotizing fasciitis has recently been reported to be as high as 55 to 87% (3)(4)(5)(6). Recent literatures revealed that monomicrobial necrotizing fasciitis caused by gram-negative pathogens, such as Vibrio vulnificus, Klebsiella pneumoniae, Aeromonas hydrophila, Pseudomonas spp.…”

“…Recent literatures revealed that monomicrobial necrotizing fasciitis caused by gram-negative pathogens, such as Vibrio vulnificus, Klebsiella pneumoniae, Aeromonas hydrophila, Pseudomonas spp. and Escherichia coli, could cause fulminant clinical courses and fatal syndrome (4)(5)(6)(7)(8)(9)(10)(11)(12).…”