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Necrotizing Soft Tissue Infection

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1. Interventions for necrotizing soft tissue infections in adults. (PubMed)

Interventions for necrotizing soft tissue infections in adults. Necrotizing soft tissue infections (NSTIs) are severe and rapidly spreading soft tissue infections of the subcutaneous tissue, fascia, or muscle, which are mostly caused by bacteria. Associated rates of mortality and morbidity are high, with the former estimated at around 23%, and disability, sequelae, and limb loss occurring in 15% of patients. Standard management includes intravenous empiric antimicrobial therapy, early surgical (...) debridement of necrotic tissues, intensive care support, and adjuvant therapies such as intravenous immunoglobulin (IVIG).To assess the effects of medical and surgical treatments for necrotizing soft tissue infections (NSTIs) in adults in hospital settings.We searched the following databases up to April 2018: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers, pharmaceutical company trial results databases, and the US Food and Drug

2018 Cochrane

2. What Is the Accuracy of Physical Examination, Imaging, and the LRINEC Score for the Diagnosis of Necrotizing Soft Tissue Infection? (SRS diagnosis)

What Is the Accuracy of Physical Examination, Imaging, and the LRINEC Score for the Diagnosis of Necrotizing Soft Tissue Infection? (SRS diagnosis) What Is the Accuracy of Physical Examination, Imaging, and the LRINEC Score for the Diagnosis of Necrotizing Soft Tissue Infection? TAKE-HOME MESSAGE Computed tomography (CT) has superior sensitivity compared with radiography for the diagnosis of necrotizing soft tissue infection, although different imaging ?ndings have various diagnostic test (...) characteristics. No single element of the physical examination, radiography, or the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score has suf?cient sensitivity to exclude necrotizing soft tissue infection. EBEM Commentators Michael D. April, MD, DPhil Brit Long, MD Department of Emergency Medicine San Antonio Uniformed Services Health Education Consortium Fort Sam, Houston, TX Jestin N. Carlson, MD, MS, and Alan Jones, MD, serve as editors of the SRS series. Editor’s Note: This is a clinical

2018 Annals of Emergency Medicine Systematic Review Snapshots

3. Necrotizing Soft Tissue Infections: A Review

Necrotizing Soft Tissue Infections: A Review Necrotizing Soft Tissue Infections: A Review | Surgical Infections Login to your account Username Password Keep me logged in Change Password Old Password New Password Password Changed Successfully Your password has (...) username Quick Search in Journals Enter words / phrases / DOI / ISBN / keywords / authors / etc Search Quick Search anywhere Enter words / phrases / DOI / ISBN / keywords / authors / etc Search Quick search in Citations Journal Year Volume Issue Page Search Reviews and and Published Online: 1 Oct 2016 Abstract Background: Soft tissue infections are a common reason for general surgical consultation. Necrotizing soft tissue infections (NSTI) are a rapidly progressive form of this infection that account

2016 Surgical Infection Society

4. Timing of Operative Debridement for Necrotizing Soft Tissue

. Address for reprints: Rondi B. Gelbard, MD, Emory University School of Medicine, 69 Jesse Hill Jr. Drive, SE, Glenn Memorial Building, Room 315, Atlanta, Georgia 30303; email: . Abstract BACKGROUND Necrotizing soft tissue infections (NSTI) are rare, life-threatening, soft-tissue infections characterized by rapidly spreading inflammation and necrosis of the skin, subcutaneous fat, and fascia. While it is widely accepted that delay in surgical debridement contributes to increased mortality (...) diagnosis. Institutional and regional systems should be optimized to facilitate prompt surgical evaluation and debridement. LEVEL OF EVIDENCE Systematic review/meta-analysis, level IV. Necrotizing soft tissue infections (NSTI) are severe and rapidly progressing infections with extremely high morbidity and mortality rates. The term “necrotizing soft tissue infection” encompasses all types of infection involving any layers of the soft tissue including superficial fascia, deep fascia or muscle

2018 Eastern Association for the Surgery of Trauma

5. Necrotizing Soft Tissue Infection: Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC Score: A Systematic Review and Meta-Analysis

Necrotizing Soft Tissue Infection: Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC Score: A Systematic Review and Meta-Analysis We sought to summarize accuracy of physical examination, imaging, and Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score in diagnosis of necrotizing soft tissue infection (NSTI) in adults with a soft tissue infection clinically concerning for NSTI.NSTI is a life-threatening diagnosis. Delay to diagnosis and surgical management

2018 EvidenceUpdates

6. A systematic review of skin-sparing debridement in necrotizing soft-tissue infections

A systematic review of skin-sparing debridement in necrotizing soft-tissue infections Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites

2019 PROSPERO

7. Necrotizing Soft Tissue Infections S.aureus - but not S.pyogenes- isolates display high rate of internalization and cytotoxicity toward human myoblasts. (PubMed)

Necrotizing Soft Tissue Infections S.aureus - but not S.pyogenes- isolates display high rate of internalization and cytotoxicity toward human myoblasts. Necrotizing Soft Tissue Infections (NSTIs) caused by group A Streptococcus (GAS) and occasionally by Staphylococcus aureus (SA) frequently involve the deep fascia and often lead to muscle necrosis.To assess the pathogenicity of GAS and SA for muscles in comparison to keratinocytes, adhesion and invasion of NSTI-GAS and NSTI-SA isolates were (...) assessed on these cells, Bloodstream infections (BSI-SA) and non-invasive coagulase negative Staphylococci (CNS) isolates were used as controls.NSTI-SA and BSI-SA exhibited stronger internalization into human keratinocytes and myoblasts than NSTI-GAS or CNS. SA internalization reached over 30% in human myoblasts due to a higher percentage of infected myoblasts (>11%) as compared to keratinocytes (<3%). Higher cytotoxicity for myoblasts of NSTI-SA as compared to BSI-SA, was attributed to higher levels

2019 Journal of Infectious Diseases

8. Necrotizing soft tissue infection following routine third molar extraction: report of two cases and review of the literature. (PubMed)

Necrotizing soft tissue infection following routine third molar extraction: report of two cases and review of the literature. Necrotizing cellulitis, necrotizing fasciitis, and necrotizing myositis are a constellation of severe soft tissue infections characterized by rapid progression, dusky soft tissue changes, and edema and induration expanding beyond the clinical wound edges. The cases of two female patients with type II necrotizing soft tissue infections occurring after routine third molar (...) extraction are reported here. The patients were treated for the infections at the University of North Carolina Hospitals in 2016. Both were previously healthy. Of particular interest, recent inoculation of group A Streptococcus appears to have contributed to the infection in both cases.Copyright © 2019 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

2019 International Journal of Oral and Maxillofacial Surgery

9. Clinical parameters and outcomes of necrotizing soft tissue infections secondary to gastrointestinal fistulas. (PubMed)

Clinical parameters and outcomes of necrotizing soft tissue infections secondary to gastrointestinal fistulas. Necrotizing soft tissue infections (NSTIs) is severe surgical infections which can occur following trauma or abdominal surgery. NSTIs secondary to gastrointestinal (GI) fistula is a rare but severe complication.A retrospective cohort study was performed on all subjects presenting with GI fistulas associated NSTIs were included. Clinical characteristics, microbiological profile

2019 BMC Infectious Diseases

10. Periocular necrotizing soft tissue infection in Greater Copenhagen. (PubMed)

Periocular necrotizing soft tissue infection in Greater Copenhagen. Necrotizing soft tissue infection, also known as necrotizing fasciitis (NF), is a fast-spreading life-threatening infection that most commonly affects the lower limbs, groin, or abdomen. Periocular necrotizing fasciitis (PNF) is rare. Limited data exist on PNF immune cell subset; hence, this study aims to determine the representation of immune cell subsets in patients diagnosed with PNF using immunohistochemical stainings.All (...) patients diagnosed with PNF at Copenhagen University Hospital from 2008 to 2018 were included. Their electronic medical records and pathology reports were assessed, and available tissue specimens were reviewed and stained with monoclonal antibodies for CD1a+ Langerhans' cells, CD3+ T lymphocytes, CD15+ granulocytes, CD44+ lymphohematopoietic cells, CD68+ histiocytes, CD79α+ B lymphocytes, and FXIIIa+ dendritic macrophages and Langerhans' cells. The number of positive cells was counted, and an average

2019 Acta ophthalmologica

11. Necrotizing skin and soft-tissue infections in the intensive care unit. (PubMed)

Necrotizing skin and soft-tissue infections in the intensive care unit. Necrotizing skin and soft-tissue infections (NSTI) are rare but potentially life-threatening and disabling infections that often require intensive care unit admission.To review all aspects of care for a critically ill individual with NSTI.Literature search using Medline and Cochrane library, multidisciplinary panel of experts.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

2019 Clinical Microbiology and Infection

12. Diabetes and necrotizing soft tissue infections-A prospective observational cohort study: Statistical analysis plan. (PubMed)

Diabetes and necrotizing soft tissue infections-A prospective observational cohort study: Statistical analysis plan. Necrotizing soft tissue infections (NSTIs) are rare but carry a high morbidity and mortality. The multicenter INFECT project aims to improve the understanding of the pathogenesis, clinical characteristics, diagnosis, and prognosis of NSTIs. This article describes the study outline and statistical analyses that will be used.Within the framework of INFECT project, patients

2018 Acta Anaesthesiologica Scandinavica

13. Pivotal Role of Preexisting Pathogen-Specific Antibodies in the Development of Necrotizing Soft-Tissue Infections. (PubMed)

Pivotal Role of Preexisting Pathogen-Specific Antibodies in the Development of Necrotizing Soft-Tissue Infections. Necrotizing soft-tissue infections (NSTI) are the most severe form of bacterial-induced tissue pathology. Their unpredictable onset and rapid development into life-threatening conditions considerably complicate patient treatment. Understanding the risk factors for NSTI in individual patients is necessary for selecting the appropriate therapeutic option.We investigated the role (...) to disease progression. Thus, all patients with NSTIs included in this study exhibited a deficiency in specific antibodies directed against the causative S. pyogenes strains and the majority of their exotoxins during the initial stage of the infection. We also showed that the clinical use of IVIG during the course of infection compensates the observed antibody deficiency but is unable to halt the disease progression, once tissue necrosis has developed.These observations emphasize the requirement

2018 Journal of Infectious Diseases

14. Necrotizing Soft Tissue Infections at a Tertiary Referral Hospital in Rwanda: Epidemiology and Risk Factors for Mortality. (PubMed)

Necrotizing Soft Tissue Infections at a Tertiary Referral Hospital in Rwanda: Epidemiology and Risk Factors for Mortality. Necrotizing soft tissue infections (NSTI) are emergency surgical conditions with severe physiologic and metabolic derangement. These infections are associated with increased rates of mortality and morbidity worldwide, particularly in developing countries if not diagnosed and treated early.This prospective, observational cohort study includes all patients aged 12 and above (...) of hospital stay was 23 days (IQR 8-41). The overall mortality was 26%. Multivariate regression analysis revealed four independent predictors of mortality: presence of shock at admission [odds ratio (OR) 14.15, 95% confidence interval (CI) 0.96-208.01, p = 0.050], renal failure (OR 8.92, 95% CI 1.55-51.29, p = 0.014), infection located on the trunk (OR 5.60, 95% CI 0.99-31.62, p = 0.050), and presence of skin gangrene (OR 4.04, 95% CI 1.18-13.76, p = 0.026).In Rwanda, NSTI mortality is high and associated

2018 World Journal of Surgery

15. Optimal timing of initial debridement for necrotizing soft tissue infection: A practice management guideline from the Eastern Association for the Surgery of Trauma.

Optimal timing of initial debridement for necrotizing soft tissue infection: A practice management guideline from the Eastern Association for the Surgery of Trauma. Necrotizing soft tissue infections (NSTI) are rare, life-threatening, soft-tissue infections characterized by rapidly spreading inflammation and necrosis of the skin, subcutaneous fat, and fascia. While it is widely accepted that delay in surgical debridement contributes to increased mortality, there are currently no practice

2018 The journal of trauma and acute care surgery

16. Stenotrophomonas maltophilia Necrotizing Soft Tissue Infection in an Immunocompromised Patient (PubMed)

Stenotrophomonas maltophilia Necrotizing Soft Tissue Infection in an Immunocompromised Patient To report on the first recorded case of necrotizing soft tissue infection (NSTI) in an immunocompromised individual caused by Stenotrophomonas maltophilia in the Western Hemisphere and highlight the challenges that medical providers face in promptly diagnosing and treating NSTI in this highly vulnerable patient population.We report a case of NSTI caused by S. maltophilia in a neutropenic patient

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2018 Case reports in critical care

17. Can necrotizing soft tissue infection be reliably diagnosed in the emergency department? (PubMed)

Can necrotizing soft tissue infection be reliably diagnosed in the emergency department? Necrotizing soft tissue infections (NSTIs) are associated with a high mortality and require prompt recognition and treatment, consisting of aggressive surgical debridement and critical care support. Diagnosis is a key step, which is generally made in the operating room (OR), but the decision to debride requires guidance. This is frequently made on clinical grounds, but NSTI can be occult in presentation (...) and several other infective processes can mimic NSTI. It is unknown whether the various scoring systems described in the literature can enable clinicians to reliably diagnose NSTI in the emergency department, rather than the OR. The topic was debated at the 36thAnnual Point/Counterpoint Acute Care Surgery Conference and the following article summarizes the discussants points of view along with a summary of the evidence.Level III.

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2018 Trauma Surgery & Acute Care Open

18. A Fatal Case of Super-super Obesity (BMI >80) in a Patient with a Necrotic Soft Tissue Infection (PubMed)

A Fatal Case of Super-super Obesity (BMI >80) in a Patient with a Necrotic Soft Tissue Infection A 35-year-old man (height, 169 cm; body weight, 240 kg; BMI, 84) visited the Department of Dermatology due to left leg pain and swelling. Focused enhanced computed tomography (CT) of the left leg ruled out complications of deep venous thrombosis. Surgical exploration of the left leg resulted in a diagnosis of necrotic soft tissue infection, but amputation was ruled out due to his weight. The patient

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2018 Internal Medicine

19. Associations of Plasma Nitrite, l-Arginine and Asymmetric Dimethylarginine With Morbidity and Mortality in Patients With Necrotizing Soft Tissue Infections (PubMed)

Associations of Plasma Nitrite, l-Arginine and Asymmetric Dimethylarginine With Morbidity and Mortality in Patients With Necrotizing Soft Tissue Infections The nitric oxide system could play an important role in the pathophysiology related to necrotizing soft tissue infection (NSTI). Accordingly, we investigated the association between plasma nitrite level at admission and the presence of septic shock in patients with NSTI. We also evaluated the association between nitrite, asymmetric

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2018 Shock (Augusta, Ga.)

20. Unusual complication of bladder prolapse with subsequent diagnosis of urothelial carcinoma leading to a necrotizing soft tissue infection after radical cystectomy (PubMed)

Unusual complication of bladder prolapse with subsequent diagnosis of urothelial carcinoma leading to a necrotizing soft tissue infection after radical cystectomy There is lack of information in the literature on long-term complications of suprapubic catheters. The most common complications include urinary tract infection, bladder calculi, urine leakage and neoplastic changes. We report a case of an unusual complication of bladder prolapse, with subsequent diagnosis of urothelial carcinoma (...) , leading to a necrotizing soft tissue infection after a radical cystectomy in a patient with long-term catheterization and its management. Due to the rarity of this complication, its management has not been well studied. In this particular case, the logical indication was radical cystectomy due to the presence of bladder necrosis.

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2018 Journal of surgical case reports

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