Necrotizing Soft-Tissue Infections: Clinical Guidelines

Endorf, Frederick W; Cancio, Leopoldo C.; Klein, Matthew B.

doi:10.1097/bcr.0b013e3181b48321

Cited by 38 publications

(35 citation statements)

References 38 publications

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“…Further collaborative efforts are necessary to advance the study of NSTIs and to address these limitations. The authors propose the following: (1) development of a consensus statement of standardized definitions for NSTIs, (2) collection of data in the setting of a prospective multi-center study using the standardized definitions and following evidence-based guidelines for care,37–38 and (3) proposal of a classification system that correlates to prognosis by a panel of experts using the Delphi method and validation within the prospective study.…”

Section: Discussionmentioning

confidence: 99%

Local variations in the epidemiology, microbiology, and outcome of necrotizing soft-tissue infections: a multicenter study

Kao

Lew

Arab

et al. 2011

The American Journal of Surgery

113

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Background Necrotizing soft tissue infections (NSTIs) are rare and highly lethal. Methods Retrospective chart review of patients with NSTIs treated at 6 academic hospitals in Texas between January 1, 2004 and December 31, 2007. Patient demographics, presentation, microbiology, treatment, and outcome were recorded. Analysis of variance, chi-square, and logistic regression analysis were performed. Results Mortality rates varied between hospitals from 9 to 25% (n=296). There was significant inter-hospital variation in patient characteristics, microbiology, and etiology of NSTIs. Despite hospital differences in treatment, primarily in critical care interventions, patient age and severity of disease (reflected by shock requiring vasopressors and renal failure post-operatively) we the re main predictors of mortality. Conclusions Significant center differences occur in patient populations, etiology, and microbiology of NSTIs, even within a concentrated region. Management should be based on these characteristics given that adjunctive treatments are unproven and variations in outcome are likely due to patient disease at presentation. Summary Significant regional inter-hospital variations occurs in patient characteristics, microbiology, etiology, and management of necrotizing soft tissue infections (NSTIs) which impact outcome.

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Section: Discussionmentioning

confidence: 99%

Local variations in the epidemiology, microbiology, and outcome of necrotizing soft-tissue infections: a multicenter study

Kao

Lew

Arab

et al. 2011

The American Journal of Surgery

113

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“…La fascitis necrosante es más frecuente en pacientes con factores predisponentes, que pueden ser locales o generales (8). Los factores predisponentes generales más frecuentes son, la presencia de comorbilidades asociadas, como puede ser: diabetes mellitus, edad avanzada, tratamiento inmunosupresor, arterioesclerosis periférica, HIV, insuficiencia cardiaca, insuficiencia respiratoria, insuficiencia renal crónica, hepatopatía, cáncer, obesidad, malnutrición, alcoholismo, tabaquismo (1,2,8).…”

Section: Discussionunclassified

“…Los factores predisponentes generales más frecuentes son, la presencia de comorbilidades asociadas, como puede ser: diabetes mellitus, edad avanzada, tratamiento inmunosupresor, arterioesclerosis periférica, HIV, insuficiencia cardiaca, insuficiencia respiratoria, insuficiencia renal crónica, hepatopatía, cáncer, obesidad, malnutrición, alcoholismo, tabaquismo (1,2,8). Los factores predisponentes locales más frecuentes son la presencia de una puerta de entrada a través de un traumatismo abierto o por inoculaciones, la presencia de otras lesiones cutáneas (úlceras, varicela), quemaduras, infecciones orofaciales, la presencia de insuficiencia venosa, arteriopatía periférica, linfedema, el tratamiento con corticoides o inmunosupresores, mala higiene (1,2,8).…”

Section: Discussionunclassified

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Fascitis necrosante bilateral: a propósito de un caso

Gómez

Roca

Franco

et al. 2011

Cir. plást. iberolatinoam.

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ResumenLa fascitis necrosante es una enfermedad de origen infeccioso que afecta a la fascia muscular y progresa rá-pidamente. Para el manejo de este tipo de pacientes es clave un diagnóstico precoz y un tratamiento adecuado que combine antibioticoterapia y cirugía.Presentamos el caso de una paciente de 77 años de edad con diagnóstico de fascitis necrosante de presentación atípica por la bilateralidad de las lesiones, la ausencia de factores predisponentes y la presencia de un único germen causal. AbstractNecrotizing fasciitis is an infectious disease that involves muscular fascia and has a quickly progress. Early diagnosis and proper treatment that consists on antibiotic therapy and surgery are the key of patient management.We report the case of a 77 years old woman with necrotizing fasciitis diagnosis with atypical presentation due to bilateral skin lesions, lack of risk factors and only one germ as causal pathogen.

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“…Confirmation of this infection is usually established with surgical wound exploration and may also require an abdominal procedure 1 , 3 – 5 . Immediate surgical debridement of all obvious necrotic skin, tissue, fascia, and muscle is vital to mitigate risk of further complications and mortality 1 , 3 – 7 …”

Section: Introductionmentioning

confidence: 99%

The Need to Feed

2016

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Necrotizing soft tissue injury (NSTI) is rare with an impressively difficult and dangerous clinical course. While the importance of nutrition as part of the treatment plan for NSTI is recognized as essential to recovery, specific recommendations have not been elucidated. A review of the evidence-based guidelines and published research to accomplish wound healing is presented. The nutrition considerations in the setting of organ failure are also discussed. This article outlines a complicated case of a septic, malnourished man with Fournier's gangrene and acute kidney injury. Protein loss from exudate extracted from a negative-pressure vacuum helped estimate the amount of protein needed to accomplish wound healing and guide clinical care. Development of acute kidney injury resulted in protein restriction at the request of the consulting renal service. This restriction led to insufficient protein intake to meet needs required for wound healing as evidenced by a nitrogen balance study and analysis of wound exudate. The estimated daily protein losses through the wound were within 11-26 g protein (2-4 g nitrogen) per day. Inclusion of wound exudate nitrogen loss in nitrogen balance analyses helped resolve conflicting treatment approaches. Estimating protein loss from wound exudate allows for individualization of protein requirements.

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Necrotizing Soft-Tissue Infections: Clinical Guidelines

Cited by 38 publications

References 38 publications

Local variations in the epidemiology, microbiology, and outcome of necrotizing soft-tissue infections: a multicenter study

Local variations in the epidemiology, microbiology, and outcome of necrotizing soft-tissue infections: a multicenter study

Fascitis necrosante bilateral: a propósito de un caso

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