Outcomes in necrotizing soft tissue infections treated with therapeutic plasma exchange

Saifee, Nabiha Huq; Evans, Heather L.; Magaret, Amalia; Hess, John R.; Delaney, Meghan; O’Keefe, Grant E.; Pham, Tam N.; Foy, Hugh M.; Bulger, Eileen M.; Pagano, Monica B.

doi:10.1111/trf.14067

Cited by 8 publications

(12 citation statements)

References 26 publications

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“…In addition, poor vascularization and antibiotic degradation limit antibiotic delivery to the fascial tissue (Montrief et al, 2019). In the face of these obstacles, it has been suggested that therapeutic plasma exchange can improve organ function and reduce mortality by decreasing circulating inflammatory mediators in the blood (Saifee et al, 2017). Unfortunately, this method is still not recommended as adjuvant therapy in the treatment of necrotizing soft tissue infections (Saifee et al, 2017), and surgical debridement remains the key element in the management of FG.…”

Section: Discussionmentioning

confidence: 99%

Fournier’s gangrene mortality: A 17-year systematic review and meta-analysis

El‐Qushayri

Khalaf

Dahy

et al. 2020

International Journal of Infectious Diseases

102

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Background: To provide better management of Fournier's gangrene, mortality-associated comorbidities and common etiologies were identified. Methods: A systematic search was conducted using 12 databases, followed by meticulous screening to select relevant articles. Meta-analysis and meta-regression (for possible cofounders) were both done for all possible outcomes. Results: Out of 1186 reports screened, 38 studies were finally included in the systematic review and metaanalysis. A higher risk of mortality was detected in patients with diabetes, heart disease, renal failure, and kidney disease, with risk ratios (RR) and 95% confidence intervals (95% CI) of 0.72 (0.59-0.89), 0.39 (0.24-0.62), 0.41 (0.27-0.63), and 0.34 (95% CI 0.16-0.73), respectively. However, there was no association between mortality rates and comorbid hypertension, lung disease, liver disease, or malignant disease (p > 0.05). The highest mortality rates were due to sepsis (76%) and multiple organ failure (66%), followed by respiratory (19.4%), renal (18%), cardiovascular (15.7%), and hepatic (5%) mortality. Conclusions: Modifications to the Fournier's Gangrene Severity Index (FGSI) are recommended, in order to include comorbidities as an important prognostic tool for FG mortality. Close monitoring of the patients, with special interest given to the main causes of mortality, is an essential element of the management process.

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Section: Discussionmentioning

confidence: 99%

Fournier’s gangrene mortality: A 17-year systematic review and meta-analysis

El‐Qushayri

Khalaf

Dahy

et al. 2020

International Journal of Infectious Diseases

102

View full text Add to dashboard Cite

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“…Saifee et al 56 suggested that therapeutic plasma exchange can decrease circulating inflammatory mediators in the blood and could improve organ function and reduce mortality. However, this method is still not recommended as adjuvant therapy in the treatment of necrotizing soft tissue infections.…”

Section: Plasma Exchangementioning

confidence: 99%

A contemporaneous narrative review of Fournier’s gangrene

Desai

Batura

2023

Urologia

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Introduction: Fournier’s gangrene is a necrotizing infection of the external genitalia, perineal or perianal regions and is mainly seen in males. Its main risk factors include diabetes, chronic alcoholism, HIV and other immune-compromised states. Fournier’s gangrene has an aggressive course associated with a mortality rate of 20%−30%, making early diagnosis and management very important. The Fournier Gangrene Severity Index (FGSI) has been traditionally used to predict the severity and prognosis. More recently, simplified FGSI (sFGSI) has been proposed and is helpful. However, timely diagnosis, supportive medical management and complete surgical debridement are still the cornerstones of treatment. These must be complemented with early and timely re-look debridements and appropriate reconstruction to cover soft tissue defects. This literature review aims to look at recent relevant research regards risk factors and prognostic features of Fournier’s gangrene. Methods: A search was conducted on Google Scholar and PubMed databases for all articles related to Fournier’s Gangrene. These included clinical reviews, case reports, case series and retrospective studies. Reports or studies which were not published in English were not reviewed. Various reconstructive techniques to cover the defects have also been revisited. Results: Broad-spectrum antibiotics and urgent surgical debridement are the core management principles of Fournier’s gangrene. Repeat debridement after 24 h is also recommended. Adjunctive therapies such as hyperbaric oxygen and vacuum-assisted closure are supported in most aspects of recent literature. Expectedly, there is a lack of randomised controlled studies in such emergency surgical conditions, which limits the widespread use of newer therapies to patients unresponsive to conventional management. Conclusion: Fournier’s gangrene is a urological emergency with a high mortality rate. The aggressive nature of the infection necessitates early recognition and immediate surgical intervention. Negative pressure dressing and occasional hyperbaric oxygen as adjuncts should be used more routinely, especially if there is a delayed response to conventional treatment or in severe infections.

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“…90,91 Further fluid administration should be guided by hemodynamic parameters (heart rate, blood pressure, urine output, and lactate clearance) to gauge responsiveness to initial fluid resuscitation. 89,[91][92][93][94] Vasopressors may be used to support In patients with salt or freshwater exposure, consider adding: Doxycycline…”

Section: Resuscitationmentioning

confidence: 99%

“…There is a theoretical benefit of neutralizing streptococcal toxins in NSTI associated with toxic shock syndrome; however, this has not been shown as of yet to be beneficial in the literature. 89,97 Therapeutic plasma exchange (TPE) has been considered and is thought to remove inflammatory mediators. 89 The current literature is not yet mature enough to make a recommendation at this time.…”

Section: Intravenous Immunoglobulins and Therapeutic Plasma Exchangementioning

confidence: 99%

See 1 more Smart Citation

<p>Fournier Gangrene in the Emergency Department: Diagnostic Dilemmas, Treatments and Current Perspectives</p>

Auerbach¹,

Bornstein²,

Ramzy³

et al. 2020

OAEM

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Fournier gangrene (FG) is a rare and life-threatening urosurgical emergency characterized most often by a polymicrobial infection of the perineal, genital, or perianal region. FG has an increased incidence in male patients, patients with alcoholism, and patients with immunocompromise including human immunodeficiency virus (HIV) and uncontrolled diabetes. FG often begins as a simple abscess or cellulitis with progression to necrotizing soft tissue infection (NSTI). Delays in diagnosis and treatment confer high mortality. Early recognition and high clinical suspicion are important in making a timely diagnosis, as early manifestations are often subtle. The most significant modifiable risk factor associated with NSTI mortality is delay to surgical intervention. Coordination of both inpatient medical and surgical teams to implement appropriate therapy is vital to successful outcomes. The emergency medicine clinician must be vigilant for this condition and be aware of risk factors, prognostic indicators, and proper treatment protocols to recognize FG early and initiate appropriate management. The objective of this review is to provide updated and relevant information regarding recognition, diagnosis, and management of FG for the emergency medicine provider.

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Outcomes in necrotizing soft tissue infections treated with therapeutic plasma exchange

Cited by 8 publications

References 26 publications

Fournier’s gangrene mortality: A 17-year systematic review and meta-analysis

Fournier’s gangrene mortality: A 17-year systematic review and meta-analysis

A contemporaneous narrative review of Fournier’s gangrene

<p>Fournier Gangrene in the Emergency Department: Diagnostic Dilemmas, Treatments and Current Perspectives</p>

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