Wound Culture Utility in Negative Surgical Exploration for Necrotizing Soft Tissue Infection

2019 ◽  
Vol 85 (10) ◽  
pp. 1175-1178
Author(s):  
Erin C. Howell ◽  
Jessica A. Keeley ◽  
Alexis L. Woods ◽  
Amy H. Kaji ◽  
Molly R. Deane ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Group A Streptococcus ◽  
Necrotizing Soft Tissue Infection ◽  
Management Culture ◽  
Wound Culture ◽  
Deep Wound ◽  
Necrotizing Soft Tissue Infections ◽  
Group A ◽  
Early Surgical Intervention

Early surgical intervention decreases mortality in necrotizing soft tissue infections (NSTIs). Yet, a subset of patients will not have NSTIs (non-NSTIs) at the time of exploration. We hypothesized that NSTI and non-NSTI patients had similar causative organisms and that intraoperative wound cultures could help guide management. Culture results and outcomes were compared for all patients undergoing surgery for suspected NSTIs over a seven-year-period. Of 295 patients, 240 (81.4%) had NSTIs. Of the 55 non-NSTI patients (18.6%), 50 had cellulitis and 5 had abscesses. NSTI and non-NSTI patients had similar rates of bacteremia (20.4% vs 17.6%, P = 0.66), septic shock (15.9% vs 12.7%, P = 0.68), and mortality (10.4% vs 7.2%, P = 0.62). Wound cultures were collected more often in NSTI patients (229/240, 95.4%) than in non-NSTI patients (42/55, 76.4%, P < 0.01). Non-NSTI patients had positive deep wound cultures more than half of the time (23/42, 54.8%). The microbiologic profile was similar between groups, with Methicillin Resistant Staphylococcus aureus and Group A Streptococcus occurring with the same frequency. We advocate for deep wound cultures in all patients being evaluated operatively for NSTIs even if the exploration is considered negative because these patients have similar clinical characteristics and virulent microbiology, and culture results can help guide antimicrobial therapy.

scholarly journals Correlation Between Immunoglobulin Dose Administered and Plasma Neutralization of Streptococcal Superantigens in Patients With Necrotizing Soft Tissue Infections

2020 ◽  
Vol 71 (7) ◽  
pp. 1772-1775 ◽  
Author(s):  
Helena Bergsten ◽  
Martin Bruun Madsen ◽  
Francois Bergey ◽  
Ole Hyldegaard ◽  
Steinar Skrede ◽  
...  
Keyword(s):  
Cell Proliferation ◽  
Clinical Trials ◽  
T Cell ◽  
Soft Tissue ◽  
Negative Correlation ◽  
Group A Streptococcus ◽  
T Cell Proliferation ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections ◽  
Group A

Abstract Analyses of plasma collected pre- and postadministration of intravenous immunoglobulin (IVIG) from patients with group A Streptococcus necrotizing soft tissue infections demonstrated a negative correlation between IVIG dose and toxin-triggered T-cell proliferation (r = −.67, P &lt; .0001). One 25-g IVIG dose was sufficient to yield plasma-neutralizing activity against streptococcal superantigens. Clinical Trials Registration. NCT 01790698 and NCT02111161.

scholarly journals Biofilm in group A streptococcal necrotizing soft tissue infections

JCI Insight ◽  
2016 ◽  
Vol 1 (10) ◽  
Author(s):  
Nikolai Siemens ◽  
Bhavya Chakrakodi ◽  
Srikanth Mairpady Shambat ◽  
Marina Morgan ◽  
Helena Bergsten ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections ◽  
Group A

scholarly journals The scfCDE Operon Encodes a Predicted ABC Importer Required for Fitness and Virulence during Group A Streptococcus Invasive Infection

2019 ◽  
Vol 87 (12) ◽  
Author(s):  
Rezia Era Braza ◽  
Yoann Le Breton ◽  
Kevin S. McIver
Keyword(s):  
Soft Tissue ◽  
Group A Streptococcus ◽  
Defined Medium ◽  
Growth Defect ◽  
Invasive Infection ◽  
Competitive Growth ◽  
Content Type ◽  
Wide Range ◽  
Integral Role ◽  
Group A

ABSTRACT As a strict human pathogen, Streptococcus pyogenes (group A Streptococcus, or GAS) causes a wide range of infections, from superficial to life-threatening diseases, upon dissemination. Thus, it is necessary to gain a better understanding of how GAS successfully overcomes host-mediated challenges and infects various host niches. We previously identified subcutaneous fitness (scf) genes in the clinically relevant wild-type (WT) GAS M1T1 5448 strain that are critical for fitness during murine soft-tissue infection at both 24 h and 48 h postinfection. The uncharacterized locus scfCDE was transcribed as an operon and is predicted to encode an ABC importer for nutrient uptake (e.g., amino acids). Individual scfCDE deletion mutants grew comparably to WT 5448 in rich medium but exhibited reduced fitness during competitive growth in murine soft tissue and in nutrient-limiting chemically defined medium (CDM). A deletion of the permease gene scfD resulted in a monoculture growth defect in CDM that could be rescued by addition of excess peptides, suggesting a role as an amino acid importer. Interestingly, the ΔscfC substrate-binding and ΔscfD permease mutants, but not the ΔscfE ATPase mutant, were highly attenuated in murine soft tissue. Moreover, all three genes were required for GAS survival in human blood, indicating their impact is not limited to superficial infections. As such, scfCDE plays an integral role in enhancing GAS adaptation during localized infection as well as dissemination to deeper host environments. Since scfCDE is conserved throughout Firmicutes, this work may contribute to the development of therapeutic strategies against GAS and other Gram-positive pathogens.

scholarly journals Necrotizing Soft Tissue Infection Occurring after Exposure toMycobacterium marinum

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Shivani S. Patel ◽  
M. Lance Tavana ◽  
M. Sean Boger ◽  
Soe Soe Win ◽  
Bassam H. Rimawi
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Skin Barrier ◽  
Tissue Infection ◽  
Soft Tissue Infections ◽  
Upper Limbs ◽  
Necrotizing Soft Tissue Infection ◽  
Cutaneous Infections ◽  
Fish Exposure ◽  
Necrotizing Soft Tissue Infections

Cutaneous infections caused byMycobacterium marinumhave been attributed to aquarium or fish exposure after a break in the skin barrier. In most instances, the upper limbs and fingers account for a majority of the infection sites. While previous cases of necrotizing soft tissue infections related toM. marinumhave been documented, the importance of our presenting case is to illustrate the aggressive nature ofM. marinumresulting in a persistent necrotizing soft tissue infection of a finger that required multiple aggressive wound debridements, followed by an amputation of the affected extremity, in order to hasten recovery.

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