Diagnosis and management of skin and soft tissue infections in the intensive care unit: a review

Burnham, Jason P.; Kirby, John P.; Kollef, Marin H.

doi:10.1007/s00134-016-4576-0

Cited by 61 publications

(46 citation statements)

References 68 publications

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“…Throughout the treatment, a close cooperation between surgeons and intensivists is essential in order to achieve surgical source control as early as possible in the early stage, and to facilitate reconstructive surgery later [16,17].…”

Section: Surgerymentioning

confidence: 99%

Necrotizing skin and soft-tissue infections in the intensive care unit

Peetermans

Prost

Eckmann

et al. 2020

Clinical Microbiology and Infection

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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.

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Section: Surgerymentioning

confidence: 99%

Necrotizing skin and soft-tissue infections in the intensive care unit

Peetermans

Prost

Eckmann

et al. 2020

Clinical Microbiology and Infection

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“…The selection must be done for each specific case, by doing a comprehensive assessment of the wound status and collecting clinical data of the patient's physical features (Baranoski and Ayello, 2012). The market has been introducing dressings with antimicrobial properties in accordance with the prevalent high number of skin and soft tissue infection cases (also known as acute bacterial skin structure infections) of inpatient and outpatient health care (Burnham et al, 2016;Simões et al, 2018). In particular, antibiotic-free antibacterial wound dressings are on the rise, in accordance with the constantly increasing number of bacterial species isolated from non-healing wounds that are resistant to commonly used antibiotics in the hospital setting (Piddock, 2017).…”

Section: Introductionmentioning

confidence: 99%

Response of Human Macrophages to Clinically Applied Wound Dressings Loaded With Silver

Varela

Marlinghaus

Sartori

et al. 2020

Front. Bioeng. Biotechnol.

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Wound infections constitute an increasing clinical problem worldwide. To reverse this trend, several wound dressings with antimicrobial properties have been developed. Considering the increasing presence of antibiotic-resistant microorganisms, product developers have been focusing their efforts in introducing antibiotic-free antibacterial wound dressings to the market, with silver being the most commonly incorporated antimicrobial agent. In this scenario, gaining information about the microbial and eukaryotic cells' response to these dressings is needed for a proper selection of antimicrobial dressings for the different cases of infected wounds. In particular, one insufficiently explored parameter is the effect of the dressings on the immunomodulation of macrophages, the main immune cell population participating in the repair process, because of their pivotal role in the transition of the inflammation to the proliferation phase of wound healing. In this work, three different clinically applied antimicrobial, silver impregnated wound dressings were selected: Atrauman R Ag, Biatain R Alginate Ag and PolyMem WIC Silver R Non-adhesive. Antimicrobial susceptibility tests (disk diffusion and broth dilution), cell viability evaluation (CellTiter-Blue R) and experiments to determine macrophage polarization (e.g., flow cytometry, ELISA and glucose uptake) were performed after 24 h of incubation. Among all products tested, Biatain R Alginate Ag induced the most evident bactericidal effect on Gram-positive and Gramnegative bacteria, followed by PolyMem WIC Silver R Non-adhesive, but did not show good cytocompatibility in vitro. On the other hand, Atrauman R Ag showed excellent cytocompatibility on L929 fibroblasts, HaCaT keratinocytes and THP-1 derived macrophages, but no significant antimicrobial activity was observed. Overall, it was confirmed that macrophages initiate, in fact, an alteration of their metabolism and phenotype in response to wound dressings of different composition in a short period of contact (24 h). M0 resting state macrophages common response to all silver-containing dressings used in this study was to increase the production of the anti-inflammatory cytokine TGF-β, which indicates an acquisition of M2-like macrophages characteristics.

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“…Treatment for Type III NSTI caused by Vibrio spp. should include doxycycline and ceftriaxone or cefotaxime [48]. Antibiotics should be continued until the patient has shown significant improvement and has been without a fever for 48-72 h and further debridement is no longer necessary [46].…”

Section: Skin and Soft-tissue Infectionsmentioning

confidence: 99%

“…It often is part of a localized, sometimes clinically unapparent, SSTI. However, mortality rates as high as 70% have been reported for streptococcal TSS [48,49]. Empiric antimicrobial therapy should include agents effective against drug-resistant organisms, in addition to clindamycin or linezolid for reduction of superantigen production [50][51][52][53].…”

Section: Skin and Soft-tissue Infectionsmentioning

confidence: 99%

Empiric Antibiotics for Sepsis

Buckman

Turnbull

Mazuski

2018

Surgical Infections

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Early administration of broad-spectrum antimicrobial drugs is one of the most important, if not the most important, treatment for patients with sepsis or septic shock. Drugs should be initiated as soon as possible, and the choice of should take into account patient factors, common local pathogens, hospital antibiograms and resistance patterns, and the suspected source of infection. Antimicrobial agent therapy should be de-escalated as soon as possible.

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Diagnosis and management of skin and soft tissue infections in the intensive care unit: a review

Cited by 61 publications

References 68 publications

Necrotizing skin and soft-tissue infections in the intensive care unit

Necrotizing skin and soft-tissue infections in the intensive care unit

Response of Human Macrophages to Clinically Applied Wound Dressings Loaded With Silver

Empiric Antibiotics for Sepsis

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