Necrotizing Soft Tissue Infections in South Australia: A 15-Year Review

Tam, Patrick; Kennedy, Brendan J.; Ashokan, Anushia

doi:10.1093/ofid/ofad117

Cited by 3 publications

(2 citation statements)

References 20 publications

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“…Consequently, the calculated annual incidence rate in the USA falls within the range of 8.7-10.3 cases per 100 000 individuals [3 & ]. This aligns with global incidence rates typically spanning from 0.86 to 19 cases per 100 000 person-years [5,6]. It's worth noting that European countries such as the Netherlands, tend to have lower prevalence rates (ranging between 1.1 and 1.4 cases per 100 000 person-years) [7].…”

Section: Incidence and Epidemiologysupporting

confidence: 71%

Necrotizing fasciitis: an update on epidemiology, diagnostic methods, and treatment

Allaw,

Wehbe,

Kanj

2023

Current Opinion in Infectious Diseases

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Purpose of review The aim of this review is to discuss the latest evidence of epidemiology, diagnostic methods, and treatment of necrotizing soft tissue infections (NSTIs) with a particular focus on necrotizing fasciitis (NF). Recent findings NSTIs have been historically referred to as NF but encompass a broader range of infections, with variable rates ranging from 0.86 to 32.64 per 100 000 person-years, influenced by factors such as climate and seasonal variations. They have diverse microbiological profiles categorized into different types based on the involved pathogens, including polymicrobial or monomicrobial infections caused by organisms such as group A streptococcus (GAS), Staphylococcus aureus, some Gram-negative pathogens, and filamentous fungi following trauma and natural disasters. Diagnosis relies on clinical symptoms and signs, laboratory markers, and imaging. However, the gold standard for diagnosis remains intraoperative tissue culture. Treatment involves repeated surgical debridement of necrotic tissues in addition to intravenous antibiotics. Adjuvant therapies with intravenous immunoglobulin (IVIG) and hyperbaric oxygen therapy (HBOT) might have a role. Soft tissue reconstruction may be necessary following surgery. Summary Prompt diagnosis and proper medical and surgical management of NSTI will improve outcomes.

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Section: Incidence and Epidemiologysupporting

confidence: 71%

Necrotizing fasciitis: an update on epidemiology, diagnostic methods, and treatment

Allaw,

Wehbe,

Kanj

2023

Current Opinion in Infectious Diseases

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“…Gas gangrene is a rapidly progressive, life-threatening infection of skeletal muscle caused by clostridia. Although NSTI are uncommon, they have been associated with high mortality and morbidity rates, with a global annual incidence of 0.3 to 15.5 cases per 100,000 people [ 5 ]. The usual incubation period between injury and the development of clostridial myonecrosis is two to three days but may be as short as 6 h [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Under the Skin: A Case Series of Clostridium sordellii Necrotizing Soft Tissue Infections in Patients Who Inject Drugs

Milano,

Cabanilla

2023

Cureus

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Clostridium sordellii has been well-associated as a cause of obstetric infections but is a less commonly recognized organism of necrotizing skin and soft tissue infections (NSTI). C. sordelli infections are rare with only 14 cases reported in the literature to date. These infections are often associated with profound septic shock and the mortality rate remains high. We report four patients who presented with C. sordellii NSTI over a period of two years at an academic medical center. Notably, injection drug use was the main risk factor for infection in these patients. Appropriate management of C. sordellii NSTI necessitates a combination of antibiotics and emergent surgical intervention. However, despite these efforts, the mortality rate remains high, with three of the four patients dying. Clinicians should consider NSTI in the differential diagnosis when evaluating skin and soft tissue infections in people who inject drugs. Furthermore, it is imperative to educate patients who engage in injection drug use on the potential risks associated with NSTI and inform them of warning signs that warrant immediate medical attention. The devastating consequences of C. sordellii-associated NSTI in this vulnerable population can be mitigated by enhancing awareness and facilitating early intervention.

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Risk Factors for Predicting Mortality and Amputation of Patients with Necrotizing Soft-Tissue Infections: Retrospective Analysis of 111 Cases from a Single Medical Center

Cen,

Jin,

Yin

et al. 2023

Emergency Medicine International

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Objective. Necrotizing soft-tissue infections (NSTIs) are rare clinical infections with surgical emergencies having a high mortality rate. This study aimed to investigate risk factors for mortality and amputation of patients with NSTI. Methods. We retrospectively analyzed critical factors for outcomes of 111 patients with NSTI hospitalized in our department from 1 January 1999 to 31 December 2018. NSTI diagnosis was based on the patient’s clinical characteristics, laboratory risk indicator for necrotizing fasciitis (LRINEC) score, laboratory test data, and microbiological findings in blood and wound culture. The risk factors for mortality and amputation of NSTI were determined using univariate or multivariate logistic regression analysis, receiver operating characteristics (ROC), and the area under the ROC curve (AUC) at 90 days after admission. Results. Diagnosis of 111 patients with NSTI was confirmed according to clinical features, LRINEC score, image data, laboratory findings, and microorganism culture in blood and wounds. The mortality rate was 9.91% (11/111) at day 90 follow-up. High white blood cell (WBC), low hematocrit (HCT), and multiple surgeries were identified to be critical risk factors for NSTI mortality in univariate and multivariate logistic analyses. AUCs, 95% confidence intervals (CI), and P values of risk factors were 0.699, 0.54–0.95, and P = 0.0117 for high WBC; 0.788, 0.63–0.97, and P = 0.0006 for low HCT; and 0.745, 0.59–0.90, and P = 0.0018 for multiple surgeries, respectively. These patients also had high LRINEC scores. Amputation occurred in 34.23% (38/111) of patients. Risk factors for amputation were higher age, low hemoglobin (Hb), and multiple wounds. AUCs, 95% confidence intervals (CI), and P values were 0.713, 0.11–0.32, and P < 0.0001 for higher age; 0.798, 0.08–0.29, and P = 0.0007 for low Hb; and 0.757, 0.17–0.34, and P < 0.0001 for multiple lesion sites, respectively. Conclusions. High LRINEC scores, high WBC, low HCT, and multiple surgeries were relevant to increased mortality. Higher age, low Hb, and multiple wounds were associated with amputation risk. These clinical features must be paid attention to when patients are diagnosed with NSTI.

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Necrotizing Soft Tissue Infections in South Australia: A 15-Year Review

Cited by 3 publications

References 20 publications

Necrotizing fasciitis: an update on epidemiology, diagnostic methods, and treatment

Necrotizing fasciitis: an update on epidemiology, diagnostic methods, and treatment

Under the Skin: A Case Series of Clostridium sordellii Necrotizing Soft Tissue Infections in Patients Who Inject Drugs

Risk Factors for Predicting Mortality and Amputation of Patients with Necrotizing Soft-Tissue Infections: Retrospective Analysis of 111 Cases from a Single Medical Center

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