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Necrotizing Soft Tissue Infection

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1. Interventions for necrotizing soft tissue infections in adults. Full Text available with Trip Pro

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 following routine third molar extraction: report of two cases and review of the literature. (Abstract)

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

6. Clinical parameters and outcomes of necrotizing soft tissue infections secondary to gastrointestinal fistulas. Full Text available with Trip Pro

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

7. Periocular necrotizing soft tissue infection in Greater Copenhagen. (Abstract)

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

8. Factors Affecting Mortality Following Necrotizing Soft-Tissue Infections: Randomized Prospective Study. Full Text available with Trip Pro

Factors Affecting Mortality Following Necrotizing Soft-Tissue Infections: Randomized Prospective Study. Necrotizing soft-tissue infections (NSTIs) are common in the Indian subcontinent and are associated with high morbidity and mortality. The aim of this paper was to correlate clinical factors and Acute Physiology Health and Chronic Health Evaluation (APACHE) II score with mortality following NSTI.Patients presenting to our tertiary-care center between November 1, 2014, and December 1, 2016 (...) was the most common manifestation (64%), followed by lower limb (14%). Infection was leading cause (34%) followed by trauma (16%) and prior surgery (14%). There were 16 in-hospital deaths (32%). Two groups were similar regarding age and sex. At presentation, nonsurvival group had significantly higher body surface area involvement (P = 0.001), anemia (P = 0.023), metabolic acidosis (P < 0.0001), serum creatinine (P = 0.007), and mean APACHE II score (P < 0.001). There was no difference between time from

2019 Journal of emergencies, trauma, and shock Controlled trial quality: uncertain

9. Necrotizing skin and soft-tissue infections in the intensive care unit. Full Text available with Trip Pro

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

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

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

11. What Is the Utility of Ultrasonography for the Identification of Skin and Soft Tissue Infections in the Emergency Department? Full Text available with Trip Pro

abscesses, pyomyositis, and necrotizing fasciitis. x 5 Talan, D.A., Mower, W.R., Krishnadasan, A. et al. Trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin abscess. N Engl J Med . 2016 ; 374 : 823–832 | | | , x 6 Pulia, M.S., Calderone, M.R., Meister, J.R. et al. Update on management of skin and soft tissue infections in the emergency department. Curr Infect Dis Rep . 2014 ; 16 : 418 | | | , x 7 Kumar, M.P., Seif, D., Perera, P. et al. Point-of-care ultrasound in diagnosing pyomyositis (...) What Is the Utility of Ultrasonography for the Identification of Skin and Soft Tissue Infections in the Emergency Department? What Is the Utility of Ultrasonography for the Identification of Skin and Soft Tissue Infections in the Emergency Department? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 70, Issue 4, Pages 580–582 What Is the Utility of Ultrasonography for the Identification of Skin

2017 Annals of Emergency Medicine Systematic Review Snapshots

12. Associations of Plasma Nitrite, l-Arginine and Asymmetric Dimethylarginine With Morbidity and Mortality in Patients With Necrotizing Soft Tissue Infections Full Text available with Trip Pro

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

2018 Shock (Augusta, Ga.)

13. Can necrotizing soft tissue infection be reliably diagnosed in the emergency department? Full Text available with Trip Pro

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.

2018 Trauma Surgery & Acute Care Open

14. A Fatal Case of Super-super Obesity (BMI >80) in a Patient with a Necrotic Soft Tissue Infection Full Text available with Trip Pro

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

2018 Internal Medicine

15. Stenotrophomonas maltophilia Necrotizing Soft Tissue Infection in an Immunocompromised Patient Full Text available with Trip Pro

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

2018 Case reports in critical care

16. Diabetes and necrotizing soft tissue infections-A prospective observational cohort study: Statistical analysis plan. Full Text available with Trip Pro

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 (...) with NSTI at 5 Scandinavian hospitals are enrolled in a prospective observational cohort study. The goal is to evaluate outcome and characteristics for patients with NSTI and diabetes compared to patients with NSTI without diabetes. The primary outcome is mortality at 90 days after inclusion. Secondary outcomes include days alive and out of ICU and hospital, SAPS II, SOFA score, infectious etiology, amputation, affected body area, and renal replacement therapy. Comparison in mortality between patients

2018 Acta Anaesthesiologica Scandinavica

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

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

18. Pivotal Role of Preexisting Pathogen-Specific Antibodies in the Development of Necrotizing Soft-Tissue Infections. Full Text available with Trip Pro

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

19. Unusual complication of bladder prolapse with subsequent diagnosis of urothelial carcinoma leading to a necrotizing soft tissue infection after radical cystectomy Full Text available with Trip Pro

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.

2018 Journal of surgical case reports

20. Identifying main causative organisms causing necrotizing soft tissue infections (NSTI) in different geographical locations a systematic review and meta-analysis

Identifying main causative organisms causing necrotizing soft tissue infections (NSTI) in different geographical locations a systematic review and meta-analysis 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

2020 PROSPERO

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