Necrotizing soft-tissue infections in New Caledonia: Epidemiology, clinical presentation, microbiology, and prognostic factors

Kha, Pauline; Colot, Julien; Gervolino, Shirley; Guerrier, Gilles

doi:10.1016/j.asjsur.2015.10.008

Cited by 15 publications

(20 citation statements)

References 13 publications

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“…The demographics of our cohort display the same trends as have been described in other studies (Table ). NSTI patients, both survivors and non‐survivors, were older than abscess patients (p‐value 0.029 and 0.005, respectively).…”

Section: Resultssupporting

confidence: 60%

“…Part of the reason for this gap in knowledge could be a lack of fundamental information regarding the microorganisms involved in NSTIs. There have been numerous reports on the microbiology of NSTIs , but they have almost always used data obtained by traditional culture methods. Furthermore, many institutions report culture‐negative results in a rapidly progressive wound bed , further illustrating the restraints of culture‐based diagnostics.…”

Section: Discussionmentioning

confidence: 99%

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Obligate anaerobes are abundant in human necrotizing soft tissue infection samples – a metagenomics analysis

Zhao-Fleming

Wilkinson²,

Larumbe

et al. 2019

APMIS

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Necrotizing soft tissue infections (NSTIs) are associated with high morbidity and mortality and are increasing in incidence. Proper identification of the microbial causes of NSTIs is a crucial step in diagnosis and treatment, but the majority of data collected are culture based, which is biased against fastidious organisms, including obligate anaerobes. The goal of this study was to address this gap in knowledge by characterizing NSTI microbial communities through molecular diagnostics. We performed 16S rRNA sequencing on human NSTI samples and identified five genera most commonly found in NSTIs (Prevotella, Bacteroides, Peptoniphilus, Porphyromonas, and Enterococcus). We found that a >70% contribution of obligate anaerobes to the bacterial population distribution was associated with NSTI mortality, and that NSTI samples, from both survivors and non‐survivors, had an increased relative abundance of gram negative bacteria compared to those of abscess patients. Based on our data, we conclude that obligate anaerobes are abundant in NSTIs and a high relative abundance of anaerobes is associated with a worse outcome. We recommend increasing anaerobe antibiotic coverage during the treatment of NSTIs even when anaerobes are not found by traditional clinical microbiology methods, and especially when there is a clinical suspicion for anaerobe involvement.

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Section: Resultssupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Obligate anaerobes are abundant in human necrotizing soft tissue infection samples – a metagenomics analysis

Zhao-Fleming

Wilkinson²,

Larumbe

et al. 2019

APMIS

View full text Add to dashboard Cite

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“…However, because of the severity of illness, underlying co-morbidities and intensity of postoperative wound care, ICU admission is frequently required [22,23,26e31]. Onequarter to one-half of patients with NSTI develop septic shock [23,29,30,32] and/or require mechanical ventilation [26,29,33] and a third exhibit acute kidney injury [30,33,34]. Organ failures tend to worsen in the first 24 hours of admission [34].…”

Section: Epidemiologymentioning

confidence: 99%

“…Co-morbidities associated with NSTI include diabetes mellitus in 22%e59% [22,23,26,27,29e31,33,35e37,39,42] and obesity in 17%e31% [26,30,35e37,41,42]. Other risk factors include cardiovascular disease (9%e45%) or peripheral vascular disease (3%e19%) [22,23,26,30,31,33,36,39,41,42], intravenous drug use (2%e80%) [27,33,36,39], immunosuppression (4%e30%) [23,25,30,35,36,42] and chronic alcohol abuse (6%e27%) [30,33] (Table 1). Of note, up to onequarter of patients with NSTI have no obvious predisposing factor [30,36,37,39].…”

Section: Epidemiologymentioning

confidence: 99%

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Necrotizing skin and soft-tissue infections in the intensive care unit

Peetermans

Prost

Eckmann

et al. 2020

Clinical Microbiology and Infection

104

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Background: Necrotizing skin and soft-tissue infections (NSTI) are rare but potentially life-threatening and disabling infections that often require intensive care unit admission. Objectives: To review all aspects of care for a critically ill individual with NSTI. Sources: Literature search using Medline and Cochrane library, multidisciplinary panel of experts. Content: The initial presentation of a patient with NSTI can be misleading, as features of severe systemic toxicity can obscure sometimes less impressive skin findings. The infection can spread rapidly, and delayed surgery worsens prognosis, hence there is a limited role for additional imaging in the critically ill patient. Also, the utility of clinical scores is contested. Prompt surgery with aggressive debridement of necrotic tissue is required for source control and allows for microbiological sampling. Also, prompt administration of broad-spectrum antimicrobial therapy is warranted, with the addition of clindamycin for its effect on toxin production, both in empirical therapy, and in targeted therapy for monomicrobial group A streptococcal and clostridial NSTI. The role of immunoglobulins and hyperbaric oxygen therapy remains controversial. Implications: Close collaboration between intensive care, surgery, microbiology and infectious diseases, and centralization of care is fundamental in the approach to the severely ill patient with NSTI. As many aspects of management of these rare infections are supported by low-quality data only, multicentre trials are urgently needed.

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Nekrotisierende Fasziitis der Extremitäten und des Stamms

Eckmann

Maier

2019

Chirurg

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Necrotizing soft-tissue infections in New Caledonia: Epidemiology, clinical presentation, microbiology, and prognostic factors

Abstract: NSTIs are particularly frequent in New Caledonia. Local health care workers should have a high index of suspicion for the disease to initiate surgical and medical treatments early.

Cited by 15 publications

References 13 publications

Obligate anaerobes are abundant in human necrotizing soft tissue infection samples – a metagenomics analysis

Obligate anaerobes are abundant in human necrotizing soft tissue infection samples – a metagenomics analysis

Necrotizing skin and soft-tissue infections in the intensive care unit

Nekrotisierende Fasziitis der Extremitäten und des Stamms

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