Nekrotisierende Fasziitis der Extremitäten und des Stamms

Recurrent Necrotizing Fasciitis: A Case Report of Fulminant and Sub-Acute Necrotizing Fasciitis in a Diabetic Patient

“…This allows entry of the offending organism(s). NSTI may be polymicrobial or monomicrobial in nature [1,2,14]. The infection moves through the deeper layers of the soft tissues, along the fascial planes, hence given the name of necrotizing fasciitis, a vigorous immune response subsequently occurs with extensive neutrophil rich inflammation [15].…”

“…Diabetes mellitus is a risk factor in up to 70% of all NSTI patients, including the Fournier's gangrene subtype [2,4,5,8,9,[11][12][13][14][15][16][17][18]. Additional commonly described risk factors include increasing age, chronic liver disease, chronic kidney disease, obesity, immunosuppression, underlying malignancy, and poor hygiene [5,10,12,16].…”

“…The literature consensus for management of all NSTI is centred on resuscitation of the patient to minimise end-organ damage, broad-spectrum antibiotics, and immediate, radical resection of affected tissue [1][2][3][4][5]8,9,[11][12][13][14][15][16][17][18]. Time to surgery is often described as the most important determinant for reducing mortality and morbidity [5,[12][13][14][15]. A delay in diagnosis and surgical debridement of both NSTIs generally as well as Fournier's gangrene increases the area of tissue involvement and increases mortality [1,3,5,12,15].…”

“…This in conjunction with the length of hospital stay demonstrates the severity of the disease. Many authors describe the need for radical resection as being judicious, and attempting to conserve tissue may result in poorer outcomes [1][2][3]5,[8][9][10][11][12][14][15][16][17][18].…”

“…Broad-spectrum antibiotics should cover S. aureus (including MRSA if locally indicated) and S. pyogenes as well as gram negative aerobes and anaerobes. NSTI are commonly polymicrobial [1,5,10,12,14]. Specific types of NSTI such as Fournier's gangrene are likely to involve gram negative organisms, so the use of metronidazole has been suggested [1,10].…”