, Volume 82, Issue 3, pp 213-219

Fulminant necrotizing soft tissue infections due to Streptococcus pyogens

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Abstract

Aim-Background

Necrotizing soft tissue infection (NSTI) is a rapidly progressive soft tissue infection with high morbidity and mortality rates. It has an incidence of approximately 1000 cases per year in the United States. Severe invasive group A Streptococcus infections associated with bacteraemia and septic shock have occurred with increasing incidence. Early recognition and prompt medical and surgical intervention are necessary to reduce morbidity and mortality rates. We present two cases of fulminant group A streptococcal necrotizing soft tissue infections.

Method

During the last year, two patients were admitted to our clinic with fulminant necrotizing soft tissue infection caused by streptococcus pyogens. The initial lesions progressed rapidly to NSTI associated with sepsis, despite the immediate antibiotic therapy. An aggressive and extensive surgical debridement of necrotic tissue was performed. Postoperatively, continuous saline dressings were applied as well as antibiotic coverage. A plastic surgery consult was obtained to discuss closure options.

Results

Despite the initial antibiotic therapy, there were no signs of improvement until an aggressive surgical intervention was performed that showed immediate signs of recovery.

Conclusion

Early diagnosis and treatment of fulminant soft tissue infections is imperative for a patient’s survival. The cornerstone of therapy of NSTI is surgical debridement, combined with appropriate antibiotic therapy and careful patient monitoring.