Necrotizing Soft Tissue Infections (NSTI): Pearls and Pitfalls for the Emergency Clinician

Pelletier, Jessica; Gottlieb, Michael; Long, Brit; Perkins, John C.

doi:10.1016/j.jemermed.2021.12.012

Cited by 19 publications

(26 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A score of six or higher is highly suspicious for NF. Although initial reports have indicated high sensitivity, later studies have shown lower sensitivity [23] and a lower score does not exclude NF [18]. The sensitivity and specificity of LRINEC score of six were only 68.2% and 84.8%, respectively, in a recent systematic review and meta-analysis [23].…”

Section: Necrotizing and Non-necrotizing Fascitiismentioning

confidence: 97%

“…Patients are usually younger with trauma being a common method of inoculation. Vibrio and Clostridium species (type 3) and fungi (type 4) are additional causative organisms [10,18]. Predisposing factors include diabetes, obesity, immunosuppressed states, trauma (which can be minor, such as insect bites), intravenous drug use, venous insufficiency, and peripheral vascular disease.…”

Section: Necrotizing and Non-necrotizing Fascitiismentioning

confidence: 99%

“…There is a wide variation in clinical presentation, but patients often present with signs and symptoms similar to cellulitis. This includes soft-tissue swelling, erythema, pain, tenderness, and fever [18]. Pain that is out of proportion to clinical findings, tenderness extending beyond the region of skin manifestation, and wooden hard feel of the subcutaneous tissues are important clinical indicators of deep involvement.…”

Section: Necrotizing and Non-necrotizing Fascitiismentioning

confidence: 99%

“…Crepitus may be felt as if there is soft tissue gas which forms with polymicrobial and clostridial infections [10]. Toxic shock syndrome may be seen with Streptococcal infection, further adding to the disease severity [18].…”

Section: Necrotizing and Non-necrotizing Fascitiismentioning

confidence: 99%

See 3 more Smart Citations

Imaging of Musculoskeletal Soft-Tissue Infections in Clinical Practice: A Comprehensive Updated Review

et al. 2022

View full text Add to dashboard Cite

Musculoskeletal soft-tissue infections include a wide range of clinical conditions that are commonly encountered in both emergency departments and non-emergency clinical settings. Since clinical signs, symptoms, and even laboratory tests can be unremarkable or non-specific, imaging plays a key role in many cases. MRI is considered the most comprehensive and sensitive imaging tool available for the assessment of musculoskeletal infections. Ultrasound is a fundamental tool, especially for the evaluation of superficially located diseases and for US-guided interventional procedures, such as biopsy, needle-aspiration, and drainage. Conventional radiographs can be very helpful, especially for the detection of foreign bodies and in cases of infections with delayed diagnosis displaying bone involvement. This review article aims to provide a comprehensive overview of the radiological tools available and the imaging features of the most common musculoskeletal soft-tissue infections, including cellulitis, necrotizing and non-necrotizing fasciitis, foreign bodies, abscess, pyomyositis, infectious tenosynovitis, and bursitis.

show abstract

Section: Necrotizing and Non-necrotizing Fascitiismentioning

confidence: 97%

Section: Necrotizing and Non-necrotizing Fascitiismentioning

confidence: 99%

Section: Necrotizing and Non-necrotizing Fascitiismentioning

confidence: 99%

Section: Necrotizing and Non-necrotizing Fascitiismentioning

confidence: 99%

See 2 more Smart Citations

Imaging of Musculoskeletal Soft-Tissue Infections in Clinical Practice: A Comprehensive Updated Review

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Vancomycin, linezolid, or clindamycin plus imipenem, meropenem, ampicillin/sulbactam, tigecycline and piperacillin/tazobactam, or ceftriaxone–metronidazole have been recommended for the initial antibiotic regimen for treating necrotizing fasciitis [ 19 , 20 , 21 , 22 , 23 ]. Our previous study advised the usage of ceftriaxone with/without other regimens at the first suspicion of necrotizing fasciitis to cover Gram-positive, Gram-negative, and anaerobic organisms [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Rational Use of Ceftriaxone in Necrotizing Fasciitis and Mortality Associated with Bloodstream Infection and Hemorrhagic Bullous Lesions

et al. 2022

View full text Add to dashboard Cite

Necrotizing fasciitis (NF) is an uncommon life-threatening necrotizing skin and soft tissue infection. The formation of hemorrhagic bullae is a special skin sign of NF. The purposes of this study were to investigate the incidence of hemorrhagic bullae formation and bacteremia associated with different organisms, to appraise the appropriate use of ceftriaxone, and to compare the clinical and laboratory risk indicators of NF patients with Gram-positive and Gram-negative infections on the initial examination. Methods: From March 2018 to December 2020, there were seventy-four NF patients with positive monomicrobial bacterial cultures enrolled based on surgical confirmation, and were categorized into two groups: the Gram-positive group and the Gram-negative group. Ceftriaxone susceptibility tests were carried out using the standard disk diffusion technique. Data, such as demographics, clinical outcomes, microbiological results, presentations of hemorrhagic bullae, and laboratory findings, were compared among these two groups. Results: The Gram-negative group included 52 patients, of whom 6 patients died, resulting in a mortality rate of 11.5%. The Gram-positive group included 22 patients and none died. Patients with bacteremia, hemorrhagic bullae, shock, fever, higher segmented forms and banded forms, and lower platelet counts constituted higher proportions in the Gram-negative group than in the Gram-positive group. The multivariate analysis identified six variables for the differentiation of Gram-negative and Gram-positive NF: the presentation of bacteremia, hemorrhagic bullae, shock at first consultation, fever with body temperature > 38.5 °C, band forms > 0%, and segmented forms ≦ 74%. A total of 66 isolates (89.2%) was susceptible to ceftriaxone. Conclusions: Gram-negative NF patients were significantly associated with hemorrhagic bullae presentation, blood stream infection, and mortality. Physicians should be alert to NF patients with the appearance of bacteremia, shock, fever, higher WBC banded and segmented forms, and lower platelet counts at the emergency department, with patients revealed to more likely have Gram-negative infections. Ceftriaxone with/without other appropriate antibiotics under the supervision of infectious doctors appeared to be clinically effective for the treatment of NF and blood stream infections.

show abstract

Emergency Dermatology for the Acute Care Provider

McGuire

2024

Urgent Care Emergencies

View full text Add to dashboard Cite

Necrotizing Soft Tissue Infections (NSTI): Pearls and Pitfalls for the Emergency Clinician

Cited by 19 publications

References 39 publications

Imaging of Musculoskeletal Soft-Tissue Infections in Clinical Practice: A Comprehensive Updated Review

Imaging of Musculoskeletal Soft-Tissue Infections in Clinical Practice: A Comprehensive Updated Review

Rational Use of Ceftriaxone in Necrotizing Fasciitis and Mortality Associated with Bloodstream Infection and Hemorrhagic Bullous Lesions

Emergency Dermatology for the Acute Care Provider

Contact Info

Product

Resources

About