scholarly journals Impact of prior antibiotic therapy on severe necrotizing soft-tissue infections in ICU patients: results from a French retrospective and observational study

2021 ◽  
Author(s):  
Sébastien Tanaka ◽  
Michael Thy ◽  
Parvine Tashk ◽  
Lara Ribeiro ◽  
Brice Lortat-Jacob ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Antimicrobial Therapy ◽  
Empiric Therapy ◽  
Underlying Disease ◽  
Exposed Group ◽  
Source Control ◽  
Suspected Sepsis ◽  
Unexposed Group ◽  
Lengths Of Stay ◽  
Necrotizing Soft Tissue Infections

Abstract Necrotizing soft-tissue infection (NSTI) is a life-threatening pathology that often requires management in intensive care unit (ICU). Therapies consist of early diagnosis, adequate surgical source control, and antimicrobial therapy. Whereas guidelines underline the need for appropriate routine microbiological cultures before starting antimicrobial therapy in patients with suspected sepsis or septic shock, delaying adequate therapy also strongly increases mortality. The aim of the present study was to compare the characteristics and outcomes of patients hospitalized in ICU for NSTI according to their antimicrobial therapy exposure > 24 h before surgery (called the exposed group) or not (called the unexposed group) before surgical microbiological sampling. We retrospectively included 100 consecutive patients admitted for severe NSTI. The exposed group consisted of 23(23%) patients, while 77(77%) patients belonged to the unexposed group. The demographic and underlying disease conditions were similar between the two groups. Microbiological cultures of surgical samples were positive in 84 patients and negative in 16 patients, including 3/23 (13%) patients and 13/77 (17%) patients in the exposed and unexposed groups, respectively (p = 0.70). The distribution of microorganisms was comparable between the two groups. The main antimicrobial regimens for empiric therapy were also similar, and the proportions of adequacy were comparable (n = 60 (84.5%) in the unexposed group vs. n = 19 (86.4%) in the exposed group, p = 0.482). ICU and hospital lengths of stay and mortality rates were similar between the two groups. In conclusion, in a population of severe ICU NSTI patients, antibiotic exposure before sampling did not impact either culture sample positivity or microbiological findings.

Hyperbaric oxygen therapy as an adjuvant to source control in necrotizing soft tissue infections

2017 ◽  
Vol 44 (6) ◽  
pp. 535-542
Author(s):  
António Pedro Pinto Ferreira ◽  
◽  
Sérgio Santos Vide ◽  
Tiago David Fonseca Fernandes ◽  
Pedro Miguel Barata de Silva Coelho ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Source Control ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections

Principles of Empirical and Therapeutic Antimicrobial Therapy

2015 ◽  
Author(s):  
Paul Waltz ◽  
Matthew R Rosengart ◽  
Brian S. Zuckerbraun
Keyword(s):  
Soft Tissue ◽  
Antimicrobial Therapy ◽  
Surgical Patient ◽  
Soft Tissue Infections ◽  
Basic Principles ◽  
Tokyo Guidelines ◽  
High Risk Factors ◽  
Surgical Infections ◽  
Necrotizing Soft Tissue Infections ◽  
Abdominal Infections

The goal of this review is to discuss basic principles for the appropriate use of antibiotics in the surgical patient, largely focusing on the treatment of intra-abdominal infections. Limited pharmacologic data on common antibiotics are provided. Current reference sources and institutional guidelines should be used for specifics on dosing and administration. This review covers general principles, including treatment of surgical infections, laboratory tests, pharmacokinetics and pharmacodynamics, adverse reactions, antimicrobial resistance, and antibiotic prophylaxis in surgical patients. In addition,  specific considerations of appropriate antimicrobial therapy, such as acute cholecystitis/cholangitis, pancreatitis, appendicitis, diverticulitis, Clostridium difficile, and skin and soft tissue infections are presented. Tables list high-risk factors in intra-abdominal infections, empirical antibiotic based on risk stratification for the treatment of community-acquired intra-abdominal infections, dose adjustments for obese patients, most common isolated pathogens from intra-abdominal infections, 2005–2010, with resistance trends, adaptation of Tokyo guidelines on severity scoring and recommended antimicrobial therapy,  and recommended antibiotics for necrotizing soft tissue infections. This review contains 6 tables and 56 references

Principles of Empirical and Therapeutic Antimicrobial Therapy

2015 ◽  
Author(s):  
Matthew R Rosengart ◽  
Paul Waltz ◽  
Brian S. Zuckerbraun
Keyword(s):  
Soft Tissue ◽  
Antimicrobial Therapy ◽  
Surgical Patient ◽  
Soft Tissue Infections ◽  
Basic Principles ◽  
Tokyo Guidelines ◽  
High Risk Factors ◽  
Surgical Infections ◽  
Necrotizing Soft Tissue Infections ◽  
Abdominal Infections

The goal of this review is to discuss basic principles for the appropriate use of antibiotics in the surgical patient, largely focusing on the treatment of intra-abdominal infections. Limited pharmacologic data on common antibiotics are provided. Current reference sources and institutional guidelines should be used for specifics on dosing and administration. This review covers general principles, including treatment of surgical infections, laboratory tests, pharmacokinetics and pharmacodynamics, adverse reactions, antimicrobial resistance, and antibiotic prophylaxis in surgical patients. In addition,  specific considerations of appropriate antimicrobial therapy, such as acute cholecystitis/cholangitis, pancreatitis, appendicitis, diverticulitis, Clostridium difficile, and skin and soft tissue infections are presented. Tables list high-risk factors in intra-abdominal infections, empirical antibiotic based on risk stratification for the treatment of community-acquired intra-abdominal infections, dose adjustments for obese patients, most common isolated pathogens from intra-abdominal infections, 2005–2010, with resistance trends, adaptation of Tokyo guidelines on severity scoring and recommended antimicrobial therapy,  and recommended antibiotics for necrotizing soft tissue infections. This review contains 6 tables and 56 references

Short Courses of Antibiotics Are Safe in Necrotizing Soft Tissue Infections

2021 ◽  
pp. 000313482110517
Author(s):  
Maria G. Valadez ◽  
Neil Patel ◽  
Vince Chong ◽  
Brant A. Putnam ◽  
Ashkan Moazzez ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Debridement ◽  
Morbidity And Mortality ◽  
Source Control ◽  
High Morbidity ◽  
Soft Tissue Infections ◽  
Short Course ◽  
Significant Difference ◽  
Necrotizing Soft Tissue Infections ◽  
Antibiotic Courses

Introduction Necrotizing soft tissue infections (NSTIs) carry high morbidity and mortality. While early aggressive surgical debridement is well-accepted treatment for NSTIs, the optimum duration of adjunct antibiotic therapy is unclear. An increasing focus on safety and evidence-based antimicrobial stewardship suggests a value in addressing this knowledge gap. Objective To determine whether shorter antibiotic courses have similar outcomes compared to longer courses in patients with NSTI following adequate source control. Population 142 consecutive patients with surgically managed NSTI were identified on retrospective chart review between December 2014 and December 2018 at two academic medical centers. Results Patients were predominately male (74%) with a median age of 52 and similar baseline characteristics. The median number of debridements to definitive source control was 2 (IQR 1-3) with the short course group undergoing a greater number of debridements control 2.57 ± 1.8 vs 1.9 ± 1.2, ( P = .01). Of 142 patients, 34.5% received a short course and the remaining 65.5% received a longer course of antibiotics. There was no significant difference in the incidence of bacteremia or wound culture positivity between groups. There was also no significant difference in in-hospital mortality, 8% vs 6, ( P = .74), incidence of C. difficile infection, median length of stay, or 30-day readmission. Conclusion Provided adequate surgical debridement, similar outcomes in morbidity and mortality suggest antibiotic courses of 7 days or less are equally safe compared to longer courses.

scholarly journals Necrotizing Soft Tissue Infections: A Focused Review of Pathophysiology, Diagnosis, Operative Management, Antimicrobial Therapy, and Pediatrics

2020 ◽  
Vol 21 (2) ◽  
pp. 81-93
Author(s):  
Jeffrey M. Tessier ◽  
James Sanders ◽  
Massimo Sartelli ◽  
Jan Ulrych ◽  
Belinda De Simone ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Antimicrobial Therapy ◽  
Operative Management ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections

scholarly journals Bowel perforation presenting as necrotizing soft-tissue infection of thigh a rare presentation

2020 ◽  
Vol 7 (12) ◽  
pp. 4206
Author(s):  
Navdeep Garg ◽  
Kunal Singla ◽  
Maninder Singh ◽  
Mandeep Singh ◽  
Rajesh Kumar Bansiwal ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bowel Perforation ◽  
Radiographic Finding ◽  
Underlying Disease ◽  
Rare Presentation ◽  
Cutaneous Manifestations ◽  
Mortality And Morbidity ◽  
Fournier Gangrene ◽  
Necrotizing Soft Tissue Infections ◽  
Delayed Recognition

Necrotizing soft-tissue infections (NSTI) are characterized by extensive and rapidly progressing soft tissue inflammation with necrosis. It typically involves a gas-forming bacterium such as group A b-hemolytic Streptococcus or a Clostridium species. This gas formation leads to the radiographic finding of subcutaneous emphysema. It is recognized as a surgical emergency. NSTI of the abdominal wall, flank, or thigh resulting from break-in bowel integrity is an atypical presentation that may cause delayed recognition and treatment, resulting in a mortality rate greater than that in Fournier gangrene. Early detection and aggressive surgical debridement are crucial to reduce patient mortality and morbidity. We present the case of a 30-year-old patient presenting with fasciitis of lower limb. Surgical exploration revealed the source of the emphysema to be an entero-cutaneous fistula. The patient had an unstable and prolonged hospitalization after debridement of the thigh and abdominal surgery and was discharged after one month. It suggested that clinical presentation can be highly variable and range from early sepsis with obvious skin involvement to minimal cutaneous manifestations of underlying disease.

Mandatory Operative Re-Exploration after Initial Debridement of Necrotizing Soft Tissue Infections: Is it Mandatory?

2017 ◽  
Vol 83 (10) ◽  
pp. 1117-1121
Author(s):  
Lara H. Spence ◽  
Huan Yan ◽  
Ashkan Moazzez ◽  
Alexander Schwed ◽  
Jessica Keeley ◽  
...  
Keyword(s):  
Septic Shock ◽  
Soft Tissue ◽  
Clinical Examination ◽  
Source Control ◽  
Soft Tissue Infections ◽  
Duration Of Symptoms ◽  
Safe Strategy ◽  
Necrotizing Soft Tissue Infections ◽  
Operative Debridement ◽  
Prompt Diagnosis

Necrotizing soft tissue infections (NSTIs) are aggressive infections requiring prompt diagnosis and extensive surgical debridement. Traditionally, patients undergo mandatory re-exploration to ensure adequacy of source control. The purpose of this study is to determine if re-exploration in the operating room is mandatory for all patients with NSTIs. An eight-year retrospective analysis of adult patients with NSTIs was performed comparing two groups: mandatory operative re-exploration versus operative re-exploration based on clinical examination findings. Outcomes measured included mortality, number of debridements, and length of stay (LOS). Twenty-two per cent of patients underwent a mandatory re-exploration. These patients were older, had a higher incidence of diabetes, and a longer duration of symptoms. There were no significant differences between groups with regard to the physical examination, severity of sepsis, time to repeat debridements, or in-hospital mortality, whereas LOS and the total number of debridements were increased in mandatory re-exploration. Bacteremia and septic shock were predictive of the need for further debridement in patients in the operative re-exploration based on clinical examination findings group. Mandatory re-exploration after initial debridement may not be necessary in all patients with NSTIs. Instead, bedside wound checks may be a safe strategy to determine the need for further operative debridement.

Principles of Empirical and Therapeutic Antimicrobial Therapy

2015 ◽  
Author(s):  
Paul Waltz ◽  
Matthew R Rosengart ◽  
Brian S. Zuckerbraun
Keyword(s):  
Soft Tissue ◽  
Antimicrobial Therapy ◽  
Surgical Patient ◽  
Soft Tissue Infections ◽  
Basic Principles ◽  
Tokyo Guidelines ◽  
High Risk Factors ◽  
Surgical Infections ◽  
Necrotizing Soft Tissue Infections ◽  
Abdominal Infections

The goal of this review is to discuss basic principles for the appropriate use of antibiotics in the surgical patient, largely focusing on the treatment of intra-abdominal infections. Limited pharmacologic data on common antibiotics are provided. Current reference sources and institutional guidelines should be used for specifics on dosing and administration. This review covers general principles, including treatment of surgical infections, laboratory tests, pharmacokinetics and pharmacodynamics, adverse reactions, antimicrobial resistance, and antibiotic prophylaxis in surgical patients. In addition,  specific considerations of appropriate antimicrobial therapy, such as acute cholecystitis/cholangitis, pancreatitis, appendicitis, diverticulitis, Clostridium difficile, and skin and soft tissue infections are presented. Tables list high-risk factors in intra-abdominal infections, empirical antibiotic based on risk stratification for the treatment of community-acquired intra-abdominal infections, dose adjustments for obese patients, most common isolated pathogens from intra-abdominal infections, 2005–2010, with resistance trends, adaptation of Tokyo guidelines on severity scoring and recommended antimicrobial therapy,  and recommended antibiotics for necrotizing soft tissue infections. This review contains 6 tables and 56 references

Effect of transfer status on outcomes for necrotizing soft tissue infections

2017 ◽  
Vol 220 ◽  
pp. 372-378 ◽  
Author(s):  
Angela M. Ingraham ◽  
Hee Soo Jung ◽  
Amy E. Liepert ◽  
Charles Warner-Hillard ◽  
Caprice C. Greenberg ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections
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