Abstract
Necrotizing soft tissue infections (NSTIs) are a true surgical emergency. These infections continue to be clinically difficult to accurately diagnose and treat. The mainstay of therapy is the initiation of broad-spectrum antibiotics and wide surgical debridement. The timing of this treatment remains the most important factor dictating morbidity and mortality.
Morgan Collom has died before the publication of this book.
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References
Kao LS, Lew DF, Arab SN, et al. Local variations in the epidemiology, microbiology, and outcome of necrotizing soft-tissue infections: a multicenter study. Am J Surg. 2011;202(2):139–45. [PubMed: 21545997]
Elliot DC, Kufera JA, Myers RA. Necrotizizng soft tissue infections: risk factors for mortality and strategies of management. Ann Surg. 1996;224:672–83.
Kiska DL, Thiede B, Caracciolo J, Jordan M, Johnson D, Kaplan EL, et al. Invasive group A streptococcal infections in North Carolina: epidemiology, clinical features, and genetic and serotype analysis of causative organisms. J Infect Dis. 1997;176(4):992–1000.
Eriksson BK, Andersson J, Holm SE, Norgren M. Epidemiological and clinical aspects of invasive group A streptococcal infections and the streptococcal toxic shock syndrome. Clin Infect Dis. 1998;27(6):1428–36.
Eriksson BK, Norgren M, McGregor K, Spratt BG, Normark BH. Group A streptococcal infections in Sweden: a comparative study of invasive and noninvasive infections and analysis of dominant T28 emm28 isolates. Clin Infect Dis. 2003;37(9):1189–93.
Darenberg J, Luca-Harari B, Jasir A, Sandgren A, Pettersson H, Schalen C, et al. Molecular and clinical characteristics of invasive group A streptococcal infection in Sweden. Clin Infect Dis. 2007;45(4):450–8.
Nichols RL, Florman S. Clinical presentations of soft-tissue infections and surgical site infections. Clin Infect Dis. 2001;33(Suppl 2):S84–93.
Bryant AE, Stevens DL. Clostridial myonecrosis: new insights in pathogenesis and management. Curr Infect Dis Rep. 2010;12(5):383–91. [PubMed: 21308521]
Vinh DC, Embil JM. Rapidly progressive soft tissue infections. Lancet Infect Dis. 2005;5(8):501–13.
Blake PA, Merson MH, Weaver RE, Hollis DG, Heublein PC. Disease caused by a marine Vibrio. Clinical characteristics and epidemiology. N Engl J Med. 1979;300(1):1–5.
Klontz KC, Lieb S, Schreiber M, Janowski HT, Baldy LM, Gunn RA. Syndromes of Vibrio vulnificus infections. Clinical and epidemiologic features in Florida cases, 1981–1987. Ann Intern Med. 1988;109(4):318–23.
Bartram L, Aaron JA. Fingal nectrotizing skin and soft tissue infections. Curr Fungal Infect Rep. 2019;13:146–56.
Wall D, Kleain S, Black S, de Virgilio C. A simple model to help distinguish necrotizing from non-necrotizing soft-tissue infections. J Am Coll Surg. 2000;191(3):227–31. [PubMed: 10989895]
Wall D, de Virgilio C, Black S, Klein S. Objective criteria may assist in distinguishing necrotizing fasciitis from nonnecrotizing sift-tissue infections. Am J Surg. 2000;179(1):17–21.
Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535–41.
Duane TM, Huston JM, Collom M, Beyer A, Parli S, Buckman S, Shapiro M, McDonald A, Diaz J, Tessier JM, Sanders J. Surgical Infection Society 2020 updated guidelines on the management of complicated skin and soft tissue infections. Surg Infect. 2021; https://doi.org/10.1089/sur.2020.436. PMID: 33646051
Hansen MB, Rasmussen LS, Pilely K, Hellemann D, Hein E, Madsen MB, et al. The lectin complement pathway in patients with necrotizing soft tissue infection. J Innate Immun. 2016;8(5):507–16.
Hansen MB, Rasmussen LS, Garred P, Bidstrup D, Madsen MB, Hyldegaard O. Pentraxin-3 as a marker of disease severity and risk of death in patients with necrotizing soft tissue infections: a nationwide, prospective, observational study. Crit Care. 2016;20:40.
Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014;51(8):344–62.
May AK, Stafford RE, Bulger EM, Heffernan D, Guillamondegui O, Bochicchio G, et al. Treatment of complicated skin and soft tissue infections. Surg Infect. 2009;10(5):467–99.
Tessier JM, Sanders J, Sartelli M, Ulrych J, De Simone B, Grabowski J, et al. Necrotizing soft tissue infections: a focused review of pathophysiology, diagnosis, operative management, antimicrobial therapy, and pediatrics. Surg Infect. 2020;21(2):81–93.
Lauerman MH, Kolesnik O, Sethuraman K, Rabinowitz R, Joshi M, Clark E, et al. Less is more? Antibiotic duration and outcomes in Fournier’s gangrene. J Trauma Acute Care Surg. 2017;83(3):443–8.
Bilton BD, Zibari GB, McMillan RW, Aultman DF, Dunn G, McDonald JC. Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study. Am Surg. 1998;64(5):397–400; discussion 400–1.
McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg. 1995;221(5):558–63; discussion 63–5.
Green RJ, Dafoe DC, Raffin TA. Necrotizing fasciitis. Chest. 1996;110(1):219–29.
Okoye O, Talving P, Lam L, Smith J, Teixeira PG, Inaba K, et al. Timing of redebridement after initial source control impacts survival in necrotizing soft tissue infection. Am Surg. 2013;79(10):1081–5.
Chang CP, Hsiao CT, Lin CN, Fann WC. Risk factors for mortality in the late amputation of necrotizing fasciitis: a retrospective study. World J Emerg Surg. 2018;13:45.
Pan A, Cauda R, Concia E, Esposito S, Sganga G, Stefani S, et al. Consensus document on controversial issues in the treatment of complicated skin and skin-structure infections. Int J Infect Dis. 2010;14(Suppl 4):S39–53.
Endorf FW, Cancio LC, Klein MB. Necrotizing soft-tissue infections: clinical guidelines. J Burn Care Res. 2009;30(5):769–75.
Linner A, Darenberg J, Sjolin J, Henriques-Normark B, Norrby-Teglund A. Clinical efficacy of polyspecific intravenous immunoglobulin therapy in patients with streptococcal toxic shock syndrome: a comparative observational study. Clin Infect Dis. 2014;59(6):851–7.
Madsen MB, Hjortrup PB, Hansen MB, Lange T, Norrby-Teglund A, Hyldegaard O, et al. Immunoglobulin G for patients with necrotising soft tissue infection (INSTINCT): a randomised, blinded, placebo-controlled trial. Intensive Care Med. 2017;43(11):1585–93.
Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg. 1996;224(5):672–83.
Holly A. Advanced necrotizing soft tissue infection in a female patient. JPEG. 2016.
Holly A. Photograph of appropriate level of debridement down to healthy tissue. Authors personal collection. 2021.
Further Reading
Duane TM, Huston JM, Collom M, Beyer A, Parli S, Buckman S, Shapiro M, McDonald A, Diaz J, Tessier JM, Sanders J. Surgical Infection Society 2020 updated guidelines on the management of complicated skin and soft tissue infections. Surg Infect. 2021; https://doi.org/10.1089/sur.2020.436. Epub ahead of print
Endorf FW, Cancio LC, Klein MB. Necrotizing soft-tissue infections: clinical guidelines. J Burn Care Res. 2009;30(5):769–75.
Sartelli M, Guirao X, Hardcastle TC, et al. 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections. World J Emerg Surg. 2018;13:58.
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Holly, A.A., Duane, T.M., Collom, M. (2023). Necrotizing Soft Tissue Infection. In: Coccolini, F., Catena, F. (eds) Textbook of Emergency General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-22599-4_113
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