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Nursing Sep 2020Necrotizing soft-tissue infections (NSTIs) are rare but rapidly progressive, life-threatening bacterial infections with high morbidity and mortality. NSTIs include... (Review)
Review
Necrotizing soft-tissue infections (NSTIs) are rare but rapidly progressive, life-threatening bacterial infections with high morbidity and mortality. NSTIs include necrotizing forms of fasciitis, myositis, and cellulitis. This article focuses on necrotizing fasciitis (NF) and discusses NF classifications, clinical features, diagnostic approaches, evidence-based treatments, and nursing interventions.
Topics: Evidence-Based Medicine; Fasciitis, Necrotizing; Humans; Nursing Diagnosis
PubMed: 32826674
DOI: 10.1097/01.NURSE.0000694752.85118.62 -
Polski Przeglad Chirurgiczny Feb 2022Necrotizing fasciitis is an uncommon, rapidly progressive, often aggressive bacterial infection that causes extensive necrosis of the subcutaneous tissue and fascia,... (Review)
Review
Necrotizing fasciitis is an uncommon, rapidly progressive, often aggressive bacterial infection that causes extensive necrosis of the subcutaneous tissue and fascia, relatively sparing the muscle and skin tissues. Rapid diagnosis of the disease is mandatory because the delay in initiation of aggressive treatment negatively influences the outcome. Specific clinical signs may not be always present, which makes an accurate and timely diagnosis difficult. Based on the literature, this article presents a review of the historical background, etiology, pathophysiology, clinical findings, diagnostic strategies, treatment and prognosis of the disease.
Topics: Humans; Fasciitis, Necrotizing
PubMed: 36805313
DOI: 10.5604/01.3001.0015.7676 -
Infectious Disease Clinics of North... Sep 2017Despite advances in antibiotic and surgical management and supportive care for necrotizing soft tissue infections, morbidity and mortality remain substantial. Although... (Review)
Review
Despite advances in antibiotic and surgical management and supportive care for necrotizing soft tissue infections, morbidity and mortality remain substantial. Although there are clinical practice guidelines in place, there still remains much variability in choice and duration of antibiotic therapy, time to initial surgical debridement, and use of adjuvant medical therapies. This article offers an overview of necrotizing soft tissue infections with a focus on current diagnostic and treatment modalities.
Topics: Administration, Intravenous; Anti-Bacterial Agents; Debridement; Disease Management; Fasciitis, Necrotizing; Gangrene; Humans; Hyperbaric Oxygenation; Immunoglobulins; Sepsis; Soft Tissue Infections
PubMed: 28779832
DOI: 10.1016/j.idc.2017.05.011 -
Ugeskrift For Laeger Sep 2022Necrotizing soft tissue infections (NSTI) is a serious infection with a mortality of up to 25% at three months. This review gives an overview of the diagnosis and... (Review)
Review
Necrotizing soft tissue infections (NSTI) is a serious infection with a mortality of up to 25% at three months. This review gives an overview of the diagnosis and treatment of NSTI. The prognosis is dependent on rapid surgical treatment, aggressive, prompt removal of infected tissue, broad spectrum antibiotic treatment and supportive care. In cases with suspected or verified infection with Streptococcus pyogenes, adjuvant therapy with immunoglobulins can be considered.
Topics: Anti-Bacterial Agents; Fasciitis, Necrotizing; Humans; Soft Tissue Infections; Streptococcus pyogenes
PubMed: 36178178
DOI: No ID Found -
The British Journal of Surgery Jan 2014Necrotizing fasciitis is a rapidly progressing skin infection characterized by necrosis of the fascia and subcutaneous tissue, accompanied by severe systemic toxicity.... (Review)
Review
BACKGROUND
Necrotizing fasciitis is a rapidly progressing skin infection characterized by necrosis of the fascia and subcutaneous tissue, accompanied by severe systemic toxicity. The objective of this systematic review was to identify clinical features and investigations that will aid early diagnosis.
METHODS
A systematic literature search of PubMed was undertaken using the keywords 'necrotising fasciitis', 'necrotising skin infection', 'diagnosis' and 'outcome'. Case series of 50 or more subjects with information on symptoms and signs at initial presentation, investigations and clinical outcome were included.
RESULTS
Nine case series were selected, with a total of 1463 patients. Diabetes mellitus was a co-morbidity in 44.5 per cent of patients. Contact with marine life or ingestion of seafood in patients with liver disease were risk factors in some parts of Asia. The top three early presenting clinical features were: swelling (80.8 per cent), pain (79.0 per cent) and erythema (70.7 per cent). These being non-specific features, initial misdiagnosis was common and occurred in almost three-quarters of patients. Clinical features that helped early diagnosis were: pain out of proportion to the physical findings; failure to improve despite broad-spectrum antibiotics; presence of bullae in the skin; and gas in the soft tissue on plain X-ray (although this occurred in only 24.8 per cent of patients).
CONCLUSION
A high index of suspicion of necrotizing fasciitis is needed in a patient presenting with cutaneous infection causing swelling, pain and erythema, with co-morbidity of diabetes or liver disease. The presence of bullae, or gas on plain X-ray can be diagnostic. Early surgical exploration is the best approach in the uncertain case.
Topics: Acute Pain; Delayed Diagnosis; Diabetes Complications; Early Diagnosis; Edema; Erythema; Fasciitis, Necrotizing; Humans; Liver Diseases; Risk Factors; Seafood; Treatment Outcome
PubMed: 24338771
DOI: 10.1002/bjs.9371 -
Clinical Microbiology and Infection :... Jan 2020Necrotizing skin and soft-tissue infections (NSTI) are rare but potentially life-threatening and disabling infections that often require intensive care unit admission. (Review)
Review
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.
Topics: Anti-Bacterial Agents; Bacteria; Critical Illness; Debridement; Disease Management; Fasciitis, Necrotizing; Humans; Intensive Care Units; Skin; Soft Tissue Infections
PubMed: 31284035
DOI: 10.1016/j.cmi.2019.06.031 -
The Annals of Otology, Rhinology, and... Feb 2023Aggressive surgical debridement is required in cervical necrotizing fasciitis, and in severe defects, subsequent free tissue transfer might be necessary. However, there...
OBJECTIVES
Aggressive surgical debridement is required in cervical necrotizing fasciitis, and in severe defects, subsequent free tissue transfer might be necessary. However, there is concern that the inflammatory environment of the infection site may threaten free flap viability, particularly with concerns for thrombosis of feeding vessels and compromised tissue integration. Cases in the head and neck area are rare, so there are limited data regarding outcomes of free tissue transfer in these patients.
METHODS
A retrospective chart review assessed patients with cervical necrotizing fasciitis treated at an academic tertiary hospital between 2015 and 2021. Twenty-five patients were identified, and eight required free tissue transfer after adequate surgical debridement. Treatment, hospital course, and demographic data were collected on these eight patients.
RESULTS
All flaps had full survival at follow up (median follow up 3 months, range 1-39 months) without concerns for vascular compromise.
CONCLUSION
These data suggest that in patients with large soft tissue defects due to cervical necrotizing fasciitis, free tissue transfer may be a safe treatment modality.
Topics: Humans; Fasciitis, Necrotizing; Retrospective Studies; Neck; Free Tissue Flaps; Debridement
PubMed: 35373592
DOI: 10.1177/00034894221088179 -
Internal Medicine (Tokyo, Japan) 2010Necrotizing fasciitis (NF) is a necrotizing soft tissue infection that can cause rapid local tissue destruction, necrosis and life-threatening severe sepsis.... (Review)
Review
Necrotizing fasciitis (NF) is a necrotizing soft tissue infection that can cause rapid local tissue destruction, necrosis and life-threatening severe sepsis. Predisposing conditions for NF include diabetes, malignancy, alcohol abuse, and chronic liver and kidney diseases. NF is classified into two categories (types 1 and 2) based on causative microorganisms. The initial clinical picture of NF mimics that of cellulitis or erysipelas, including fever, pain, tenderness, swelling and erythema. The cardinal manifestations of NF are severe pain at onset out of proportion to local findings, hemorrhagic bullae and/or vital sign abnormality. In such cases, NF should be strongly suspected and immediate surgical intervention should be considered, along with broad-spectrum antimicrobials and general supportive measures, regardless of the findings of imaging tests.
Topics: Animals; Bacterial Infections; Diabetes Complications; Fasciitis, Necrotizing; Humans
PubMed: 20558917
DOI: 10.2169/internalmedicine.49.2964 -
Journal of General Internal Medicine Jun 2022
Topics: Fasciitis, Necrotizing; Humans; Orbital Diseases
PubMed: 35304696
DOI: 10.1007/s11606-022-07484-7 -
Revista Da Sociedade Brasileira de... 2023
Topics: Humans; Fasciitis, Necrotizing; Neck
PubMed: 37792843
DOI: 10.1590/0037-8682-0379-2023