Necrotizing Soft-Tissue Infections: Clinical Features and Diagnostic Aspects

Madsen, Martin Bruun; Arnell, Per; Hyldegaard, Ole

doi:10.1007/978-3-030-57616-5_4

Cited by 5 publications

(7 citation statements)

References 69 publications

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“…The most immediate question lies with the timing of the procedure and the utility of CT scanning. FG is generally a clinical diagnosis, and the value of CT would be to determine the extent of the disease to assist with surgical planning and diagnose unclear cases [3]. However, in centres where CT is not readily available, surgery must not be delayed due to the rapidly evolving nature of the disease [3].…”

Section: Discussionmentioning

confidence: 99%

‘Case of the Month’ from Epworth Healthcare, Epworth, Australia: Fournier's gangrene following routine surgery

Huang,

Chen,

Mirabelli

et al. 2023

BJU International

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Section: Discussionmentioning

confidence: 99%

‘Case of the Month’ from Epworth Healthcare, Epworth, Australia: Fournier's gangrene following routine surgery

Huang,

Chen,

Mirabelli

et al. 2023

BJU International

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“…A necrotizing soft tissue infection (NSTI) is a life-threatening and rare diagnosis. It is an infection known for its fast onset and fulminant disease course, often resulting in sepsis, multiple organ failure, or death [ 1 , 2 ]. In 2018, the estimated incidence rate of NSTIs in the United States of America was approximately 8.3 to 10.3 cases per 100.000 persons [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

No role for standard imaging workup of patients with clinically evident necrotizing soft tissue infections: a national retrospective multicenter cohort study

Brands,

Nawijn,

Foppen

et al. 2024

Eur J Trauma Emerg Surg

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Purpose To assess the diagnostic contribution of different imaging studies to diagnose necrotizing soft tissue infections (NSTIs) and the time to surgery in relation to imaging with the hypothesis that imaging studies may lead to significant delays without being able to sufficiently dismiss or confirm the diagnosis since a NSTI is a surgical diagnosis. Methods A retrospective multicenter cohort study of all NSTI patients between 2010 and 2020 was conducted. The primary outcome was the number of cases in which imaging contributed to or led to change in treatment. The secondary outcomes were time to treatment determined by the time from presentation to surgery and patient outcomes (amputation, intensive care unit (ICU) admission, length of ICU stay, hospital stay, and mortality). Results A total of 181 eligible NSTI patients were included. The overall mortality was 21% (n = 38). Ninety-eight patients (53%) received imaging in the diagnostic workup. In patients with a clinical suspicion of a NSTI, 81% (n = 85) went directly to the operating room and 19% (n = 20) underwent imaging before surgery; imaging was contributing in only 15% (n = 3) by ruling out or determining underlying causes. In patients without a clinical suspicion of a NSTI, the diagnosis of NSTI was considered in 35% and only after imaging was obtained. Conclusion In patients with clinically evident NSTIs, there is no role for standard imaging workup unless it is used to examine underlying diseases (e.g., diverticulitis, pancreatitis). In atypical presenting NSTIs, CT or MRI scans provided the most useful information. To prevent unnecessary imaging and radiation and not delay treatment, the decision to perform imaging studies in patients with a clinical suspicion of a NSTI must be made extremely careful.

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“…NSTI presentation is greatly variable (M. B. Madsen, Arnell, et al 2020), often linked to breaches of the skin due to ulcers, trauma, or surgery, but can also occur without previous penetrating trauma ( McHenry et al 1995;Wong, H.-C. Chang, et al 2003; M. B. Madsen, Skrede, et al 2019;B.…”

Section: Symptomsmentioning

confidence: 99%

“…NSTI patients present vague symptoms (nausea, vomiting, and diarrhea (Bisno et al 2000)) and there is no particular symptom that is definitive of NSTI, making the diagnosis very challenging (M. B. Madsen, Arnell, et al 2020). This is further compounded by the fact that a quick diagnosis followed by surgery has been linked to a reduced mortality rate (Nawijn et al 2020).…”

Section: Symptomsmentioning

confidence: 99%

“…Potentially several imaging options could be utilised in the diagnostic process (M. B. Madsen, Arnell, et al 2020) including plain radiographs (Tso et al 2018), ultrasonography (Yen et al 2002), computerised tomography (Leichtle et al 2016), and magnetic resonance imaging (MRI) (Kim et al 2011;Rahmouni et al 1994). MRI has proven to be useful, particularly in limb infections (Kim et al 2011;Rahmouni et al 1994).…”

Section: Diagnosismentioning

confidence: 99%

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Peeking under the skin: deciphering enigmas underlying necrotising soft tissue infections

Jahagirdar

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Networks and network analyses are fundamental tools of systems biology. Networks are built by inferring the pair-wise relationships among biological entities from a large number of samples such that subject specific information is lost. The possibility of constructing these sample (individual)-specific networks from single molecular profiles might offer new insights in systems and personalised medicine and as a consequence is attracting more and more research interest. In this study, we evaluated and compared LIONESS (Linear Interpolation to Obtain Network Estimates for Single Samples) and ssPCC (single sample network based on Pearson correlation) in the metabolomics context of metabolite-metabolite association networks. We illustrated and explored the characteristics of these two methods on i) simulated data, ii) data generated from a dynamic metabolic model to simulate real-life observed metabolite concentration profiles, iii) 22 metabolomic data sets and iv) we applied single sample network inference to a study case pertaining to the investigation of necrotizing soft tissue infections to show how these methods can be applied in metabolomics. We also proposed some adaptation of the methods that can be used for data exploration. Overall, despite some limitations, we found single sample networks to be a promising tool for the analysis of metabolomics data.

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Necrotizing Soft-Tissue Infections: Clinical Features and Diagnostic Aspects

Cited by 5 publications

References 69 publications

‘Case of the Month’ from Epworth Healthcare, Epworth, Australia: Fournier's gangrene following routine surgery

‘Case of the Month’ from Epworth Healthcare, Epworth, Australia: Fournier's gangrene following routine surgery

No role for standard imaging workup of patients with clinically evident necrotizing soft tissue infections: a national retrospective multicenter cohort study

Peeking under the skin: deciphering enigmas underlying necrotising soft tissue infections

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