Role of early and extensive surgery in the treatment of severe necrotizing soft tissue infection

Voros, Dionysios; Pissiotis, Christos A.; Georgantas, D.; Katsaragakis, Stylianos; Antoniou, Stavros A.; Papadimitriou, J.

doi:10.1002/bjs.1800800943

Cited by 162 publications

(85 citation statements)

References 7 publications

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“…Delayed recognition is a key factor when considering the high mortality. 6 Imaging modalities such as computed tomography, magnetic resonance imaging and frozen section biopsy have been previously used in the discrimination between necrotising fasciitis and other soft tissue infections but these methods have been limited by cost and availability. 2,7,8 The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) is a clinical tool first described by Wong C et al 9 The tool is based on six common serum parameters at the time of presentation: C-reactive protein (CRP), total white cell count, haemoglobin, serum sodium, creatinine and glucose (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature

Bechar

Sepehripour

Hardwicke

et al. 2017

annals

154

106

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INTRODUCTION Early operative debridement of necrotising fasciitis is a major outcome determinant. Identification and diagnosis of such patients can be clinically difficult. The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score first published in 2004 is based on routinely performed parameters and offers a method for identifying early cases. No literature review has yet been performed on the application of such a score. METHODS A systematic review of English-language literature was performed from 2004 to 2014 to identify articles reporting use of LRINEC score and the incidence of necrotising fasciitis. We performed a critical review of PubMed, Medline and Embase in line with the PRISMA statement. A meta-analysis was performed with a random effects model and 95% confidence interval. Suitable correlation coefficient and receiver operating characteristic (ROC) curves were also calculated. RESULTS After application of inclusion criteria, 16 studies with 846 patients were included. The mean LRINEC score in patients with necrotising fasciitis was 6.06. Two papers reported LRINEC score in patients without necrotising fasciitis with a mean 2.45. All six studies with a reported coefficient of variance were < 1; Pearson correlation coefficient was r = 0.637 (P = 0.011). An ROC curve showed an area under the curve of 0.927. CONCLUSIONS The LRINEC score is a useful clinical determinant in the diagnosis and surgical treatment of patients with necrotising fasciitis, with a statistically positive correlation between LRINEC score and a true diagnosis of necrotising fasciitis.

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Section: Introductionmentioning

confidence: 99%

Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature

Bechar

Sepehripour

Hardwicke

et al. 2017

annals

154

106

View full text Add to dashboard Cite

show abstract

“…Historically, studies have shown an association between time to intervention and patient survival for those diagnosed with an NSTI [4][5][6]. Wheras a number of adjuvant therapies have been proposed-including specific therapies targeting bacterial toxins such as intravenous gamma globulin [7,8], plasmapheresis [9], and activated protein C [10,11] and the more generalized therapy of hyperbaric oxygen therapy (HBOT) [12,13]-there have been no universally accepted changes in the management of NSTI over the last three decades.…”

mentioning

confidence: 99%

Not Just Full of Hot Air: Hyperbaric Oxygen Therapy Increases Survival in Cases of Necrotizing Soft Tissue Infections

Shaw

Psoinos

Emhoff

et al. 2014

Surgical Infections

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Background: The utility of hyperbaric oxygen therapy (HBOT) in the treatment of necrotizing soft tissue infections (NSTIs) has not been proved. Previous studies have been subject to substantial selection bias because HBOT is not available universally at all medical centers, and there is often considerable delay associated with its initiation. We examined the utility of HBOT for the treatment of NSTI in the modern era by isolating centers that have their own HBOT facilities. Methods: We queried all centers in the University Health Consortium (UHC) database from 2008 to 2010 that have their own HBOT facilities (n = 14). Cases of NSTI were identified by International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes, which included Fournier gangrene (608.83), necrotizing fasciitis (728.86), and gas gangrene (040.0). Status of HBOT was identified by the presence (HBOT) or absence (control) of ICD-9 procedure code 93.95. Our cohort was risk-stratified and matched by UHC's validated severity of illness (SOI) score. Comparisons were then made using univariate tests of association and multivariable logistic regression. Results: There were 1,583 NSTI cases at the 14 HBOT-capable centers. 117 (7%) cases were treated with HBOT. Univariate analysis showed that there was no difference between HBOT and control groups in hospital length of stay, direct cost, complications, and mortality across the three less severe SOI classes (minor, moderate, and major). However, for extreme SOI the HBOT group had fewer complications (45% vs. 66%; p < 0.01) and fewer deaths (4% vs. 23%; p < 0.01). Multivariable analysis showed that patients who did not receive HBOT were less likely to survive their index hospitalization (odds ratio, 10.6; 95% CI 5.2-25.1). Conclusion: At HBOT-capable centers, receiving HBOT was associated with a significant survival benefit. Use of HBOT in conjunction with current practices for the treatment of NSTI can be both a cost-effective and life-saving therapy, in particular for the sickest patients.

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“…4 microbes per wound culture were detected. Voros D. 12 (1993) reviewed 43 patients of necrotizing soft tissue infection and he found that bacterial culture revealed 2-7 microbes in each patient.…”

Section: Bacteriologymentioning

confidence: 99%

“…66% but those patients who were operated after 5 days the mortality was 33%. Voros D. 12 (1993) reviewed 45 patients with necrotizing soft tissue infection and found that in 30 patients early diagnosis and treatment resulted in only 2 deaths and delayed surgical intervention in 12 patients was followed by 9 deaths.…”

Section: Mortality and Related Comorbid Conditionsmentioning

confidence: 99%

Clinico - Pathological Study Management and Outcome of Necrotizing Soft Tissue Infection

Maurya¹,

Yadav²,

Kala³

et al. 2015

jemds

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Role of early and extensive surgery in the treatment of severe necrotizing soft tissue infection

Cited by 162 publications

References 7 publications

Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature

Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature

Not Just Full of Hot Air: Hyperbaric Oxygen Therapy Increases Survival in Cases of Necrotizing Soft Tissue Infections

Clinico - Pathological Study Management and Outcome of Necrotizing Soft Tissue Infection

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