M Peetermans1, N de Prost2, C Eckmann3, A Norrby-Teglund4, S Skrede5, J J De Waele6. 1. Department of Critical Care, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom. 2. Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France; Groupe de Recherche Clinique CARMAS, Université Paris-Est Créteil, IMRB, Créteil, France. 3. Department of General, Visceral and Thoracic Surgery, Klinikum Peine, Academic Hospital of Medical University Hannover, Germany. 4. Centre for Infectious Medicine, Karolinska Institute, Karolinska University Hospital, Huddinge, Sweden. 5. Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway. 6. Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium. Electronic address: jan.dewaele@ugent.be.
Abstract
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.
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.
Authors: H Bergsten; L M Palma Medina; M Morgan; K Moll; D H Skutlaberg; S Skrede; T Wajima; M Svensson; A Norrby-Teglund Journal: Antimicrob Agents Chemother Date: 2021-09-07 Impact factor: 5.191
Authors: Massimo Sartelli; Federico Coccolini; Yoram Kluger; Ervis Agastra; Fikri M Abu-Zidan; Ashraf El Sayed Abbas; Luca Ansaloni; Abdulrashid Kayode Adesunkanmi; Goran Augustin; Miklosh Bala; Oussama Baraket; Walter L Biffl; Marco Ceresoli; Elisabetta Cerutti; Osvaldo Chiara; Enrico Cicuttin; Massimo Chiarugi; Raul Coimbra; Daniela Corsi; Francesco Cortese; Yunfeng Cui; Dimitris Damaskos; Nicola de'Angelis; Samir Delibegovic; Zaza Demetrashvili; Belinda De Simone; Stijn W de Jonge; Stefano Di Bella; Salomone Di Saverio; Therese M Duane; Paola Fugazzola; Joseph M Galante; Wagih Ghnnam; George Gkiokas; Carlos Augusto Gomes; Ewen A Griffiths; Timothy C Hardcastle; Andreas Hecker; Torsten Herzog; Aleksandar Karamarkovic; Vladimir Khokha; Peter K Kim; Jae Il Kim; Andrew W Kirkpatrick; Victor Kong; Renol M Koshy; Kenji Inaba; Arda Isik; Rao Ivatury; Francesco M Labricciosa; Yeong Yeh Lee; Ari Leppäniemi; Andrey Litvin; Davide Luppi; Ronald V Maier; Athanasios Marinis; Sanjay Marwah; Cristian Mesina; Ernest E Moore; Frederick A Moore; Ionut Negoi; Iyiade Olaoye; Carlos A Ordoñez; Mouaqit Ouadii; Andrew B Peitzman; Gennaro Perrone; Tadeja Pintar; Giuseppe Pipitone; Mauro Podda; Kemal Raşa; Julival Ribeiro; Gabriel Rodrigues; Ines Rubio-Perez; Ibrahima Sall; Norio Sato; Robert G Sawyer; Vishal G Shelat; Michael Sugrue; Antonio Tarasconi; Matti Tolonen; Bruno Viaggi; Andrea Celotti; Claudio Casella; Leonardo Pagani; Sameer Dhingra; Gian Luca Baiocchi; Fausto Catena Journal: World J Emerg Surg Date: 2022-01-15 Impact factor: 5.469
Authors: Morten Hedetoft; Marco Bo Hansen; Martin Bruun Madsen; Julia Sidenius Johansen; Ole Hyldegaard Journal: BMC Infect Dis Date: 2021-10-09 Impact factor: 3.090