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Essentials in the management of necrotizing soft-tissue infections

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Abstract

Aims

Necrotizing soft-tissue infections (NSTI) are rare but severe diseases with rapid progression. Rates of mortality and morbidity are high and early diagnosis, immediate surgical intervention and antibiotic treatment are essential to improve prognosis. Thus, our commentary emphasizes important information in the management of NSTI.

Methods

We describe the essentials in the management of necrotizing soft-tissue infections.

Results

Six essentials were identified:

  1. 1.

    Necrotizing soft-tissue infections (NSTI) are primarily diagnosed clinically; pain out of proportion, rapid progression of skin infection and systemic signs should alert clinicians.

  2. 2.

    Early diagnosis can be rather delayed by several factors such as absence of fever, significant cutaneous manifestations, elevation of inflammatory parameters, systemic signs, and non-specific imaging tests.

  3. 3.

    NSTI can occur both in the elderly or patients with underlying diseases after major trauma (usually polymicrobial Gram-negative and Gram-positive pathogens) but also in healthy patients after minor trauma (often monomicrobial; most common among Gram-positive organisms: group A Streptococcus).

  4. 4.

    Immediate and radical debridement (incl. re-debridement after 24 h) remains the cornerstone of surgical therapy.

  5. 5.

    Empirical broad-spectrum antimicrobial treatment has to be administered shortly after admission. After isolation of the causative bacteria therapy should be tailored.

  6. 6.

    The value of adjunctive measures (hyperbaric oxygen therapy, intravenous immunoglobulines) is uncertain and their routine use cannot be recommended.

Summary

Further efforts should be undertaken to increase the awareness for and the adherence to the essentials in the management of necrotizing soft-tissue infections.

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Author information

Authors and Affiliations

  1. Department I of Internal Medicine, University of Cologne, Cologne, Germany

    Norma Jung

  2. Department of General, Visceral and Thoracic Surgery, Klinikum Peine, Academic Hospital of Medical University Hannover, Peine, Germany

    Christian Eckmann

Authors
  1. Norma Jung
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  2. Christian Eckmann
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Corresponding author

Correspondence to Norma Jung.

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Conflict of interest

In the last 3 years NJ has received lecture fees from Gilead, Infectopharm and MSD and travel grants from Gilead, Basilea and Correvio. CE received honoraria for lectures and as consultant from Angelini, Menarini, MSD, Nabriva and Pfizer and research and travel support by ECDC, WHO and Niedersächsisches Landesgesundheitsamt.

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Jung, N., Eckmann, C. Essentials in the management of necrotizing soft-tissue infections. Infection 47, 677–679 (2019). https://doi.org/10.1007/s15010-019-01316-3

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  • DOI: https://doi.org/10.1007/s15010-019-01316-3

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