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Necrotizing Soft-Tissue Infections

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General Trauma Care and Related Aspects

Part of the book series: European Manual of Medicine ((EUROMANUAL))

Abstract

Necrotizing soft-tissue infections (NSTIs) are a heterogeneous group of life- and limb-threatening infections that can involve the skin, subcutaneous tissues, fascia and/or muscle. NSTIs can be classified according to their clinical appearance, tissue level, and/or microbiological composition. Most patients affected with NSTI suffer from chronic debilitating diseases and/or are immune-compromised. Clinical signs of NSTI are unspecific in the initial phase. Severe pain disproportional to the clinical appearance is a leading factor in the diagnosis of NSTI. Without treatment, these infections rapidly progress, leading to septic-toxic shock syndrome and multiple organ failure in an early stage. Only radical surgical treatment, including amputations, high-dose triple antibiotics, and life support may prevent a fatal outcome. Hyperbaric treatment may have a positive effect, however, extensive reconstructive plastic surgery after recovery is needed to repair the soft-tissue defects. Mortality for NSTI is 35 % for limb-affected patients and 100 % for trunk-affected patients. Clinical awareness at the onset of these infections may prevent serious complications or death.

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Bibliography

  • Ahrenholz DH (1988) Necrotizing soft-tissue infections. Surg Clin North Am 68:199–214

    PubMed  CAS  Google Scholar 

  • Baskin LS, Carroll PR, Cattolica EV, McAninch JW (1990) Necrotizing soft tissue infections of the perineum and genitalia: bacteriology, treatment, and risk assessment. Br J Urol 65:524–529

    Article  PubMed  CAS  Google Scholar 

  • Bertram P, Treutner KH, Stumpf M, Schumpelick V (2000) Postoperative necrotizing soft-tissue infections of the abdominal wall. Langenbecks Arch Surg 385:39–41

    Article  PubMed  CAS  Google Scholar 

  • Brown DR, Davis NL, Lepawsky L, Cunningham J, Kortbeek J (1994) A multi-center review of the treatment of major truncal necrotizing infections with and without hyperbaric oxygen therapy. Am J Surg 167:485–489

    Article  PubMed  CAS  Google Scholar 

  • Burge TS, Watson JD (1994) Necrotizing fasciitis: be bloody, bold and resolute. BMJ 308:1453–1454

    Article  PubMed  CAS  Google Scholar 

  • Carruthers A, Carruthers J, Wright P (1975) Necrotizing fasciitis with polymyositis. Br Med J 3:355–356

    Article  PubMed  CAS  Google Scholar 

  • Chapnick EK, Gradon JD, Lutwick LI, Kim J, Levi M, Kim HM, Sclievert P (1992) Streptococcal toxic shock syndrome due to noninvasive pharyngitis. Clin Infect Dis 14:1074–1077

    Article  PubMed  CAS  Google Scholar 

  • Cone LA, Woodward DR, Schlievert PM, Tomory GS (1993) Clinical and bacteriologic observations of a toxic shock-like syndrome due to streptococcus pyogenes. N Engl J Med 317:146–149

    Article  Google Scholar 

  • Dunbar NM, Harruff RC (2007) Necrotizing fasciitis: manifestations, microbiology and connection with black tar heroin. J Forensic Sci 52:920–923

    Article  PubMed  Google Scholar 

  • Elliott DC, Kufera JA, Myers RAM (1996) Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg 224:672–683

    Article  PubMed  CAS  Google Scholar 

  • Escobar SJ, Slade JB Jr, Hunt TK, Cianci P (2005) Adjuvant hyperbaric oxygen therapy (HBO2) for treatment of necrotizing fasciitis reduces mortality and amputation rate. Undersea Hyperb Med 32:437–443

    PubMed  CAS  Google Scholar 

  • Fast DJ, Schlievert PM, Nelson RD (1989) Toxic shock syndrome-associated staphylococcal and streptococcal pyrogenic toxins are potent inducers of tumor necrosis factor production. Infect Immun 57:291–294

    PubMed  CAS  Google Scholar 

  • Fournier JA (1884) Etude clinique de la gangrene foudroyante de la verge. Sem Med 4:69

    Google Scholar 

  • Francis KR, Lamaute HR, Davis JM, Pizzi WF (1993) Implications of risk factors in necrotizing fasciitis. Ann Surg 59:304–308

    CAS  Google Scholar 

  • Gickel SZ (1988) Hand infections in patients with acquired immunodeficiency syndrome. J Hand Surg 13A:770–775

    Google Scholar 

  • Golger A, Ching S, Goldsmith CH, Pennie RA, Bain JR (2007) Mortality in patients with necrotizing fasciitis. Plast Reconstr Surg 119:1803–1807

    Article  PubMed  CAS  Google Scholar 

  • Gomez JM, Fajardo R, Patiño JF, Arias CA (2003) Necrotizing fasciitis due to Vibrio alginolyticus in an immunocompetent patient. J Clin Microbiol 41:3427–3429

    Article  PubMed  Google Scholar 

  • Gonzales MH, Kay T, Weinzweig N, Brown A, Pulvirenti JJ (1996) Necrotizing fasciitis of the upper extremity. J Hand Surg A21:689–692

    Google Scholar 

  • Hassell M, Fagan P, Carson P, Currie BJ (2004) Streptococcal necrotizing fasciitis from diverse strains of Streptococcus pyogenes in tropical northern Australia: case series and comparison with the literature. BMC Infect Dis 4:60

    Article  PubMed  Google Scholar 

  • Hsiao CT, Weng HH, Yuan YD, Chen CT, Chen IC (2008) Predictors of mortality in patients with necrotizing fasciitis. Am J Emerg Med 26:170–175

    Article  PubMed  Google Scholar 

  • Jones J (1871) Investigation upon the nature, causes and treatment of hospital gangrene as it prevailed in the confederate armies 1861–1865. In: Hamilton FH (ed) United States Sanitary Commission, memoirs: surgical II. Riverside Press, New York, pp 146–170

    Google Scholar 

  • Kihiczak GG, Schwartz RA, Kapila R (2006) Necrotizing fasciitis: a deadly infection. J Eur Acad Dermatol Venereol 20:365–369

    Article  PubMed  CAS  Google Scholar 

  • Kimura AC, Higa JI, Levin RM, Simpson G, Vargas Y, Vugia DJ (2004) Outbreak of necrotizing fasciitis due to Clostridium sordellii among black-tar heroin users. Clin Infect Dis 38:87–91

    Article  Google Scholar 

  • Kindwall EP (1992) Uses of hyperbaric oxygen therapy in the 1990s. Cleve Clin J Med 59:517–528

    Article  PubMed  CAS  Google Scholar 

  • Kossmann T, Gattiker A, Trentz O (1998) Nekrotisierende weichteilinfektionen und “toxic shock syndrome”. Unfallchirurg 101:74–80

    Article  PubMed  CAS  Google Scholar 

  • Kuo YL, Shieh SJ, Chiu HY, Lee JW (2007) Necrotizing fasciitis caused by Vibrio vulnificus: epidemiology, clinical findings, treatment and prevention. Eur J Clin Microbiol Infect Dis 26:785–792

    Article  PubMed  Google Scholar 

  • Lee YT, Lin JC, Wang NC, Peng MY, Chang FY (2007) Necrotizing fasciitis in a medical center in northern Taiwan: emergence of methicillin-resistant Staphylococcus aureus in the community. J Microbiol Immunol Infect 40:335–341

    PubMed  Google Scholar 

  • Leitch HA, Palepu A, Fernandes CM (2000) Necrotizing fasciitis secondary to group A streptococcus, morbidity and mortality still high. Can Fam Physician 46:1460–1466

    PubMed  CAS  Google Scholar 

  • Lewis RT (1998) Soft tissue infections. World J Surg 22:146–151

    Article  PubMed  CAS  Google Scholar 

  • Liu YM, Chi CY, Ho MW et al (2005) Microbiology and factors affecting mortality in necrotizing fasciitis. J Microbiol Immunol Infect 38:430–435

    PubMed  Google Scholar 

  • McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA (1995) Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 221:558–565

    Article  PubMed  CAS  Google Scholar 

  • Meleney FL (1924) Hemolytic streptococcus gangrene. Arch Surg 9:317–364

    Article  Google Scholar 

  • Mittermair RP, Schobersberger W, Hasibeder W, Allerberger F, Peer R, Bonatti H (2002) Necrotizing fasciitis with Clostridium perfringens after laparoscopic cholecystectomy. Surg Endosc 16:716

    Article  PubMed  CAS  Google Scholar 

  • Moeller G (1993) Superantigen Immunol Rev 131:1–200

    Google Scholar 

  • Muldrew KL, Miller RR, Kressin M, Tang YW, Stratton C (2007) Necrotizing fasciitis from Vibrio vulnificus in a patient with undiagnosed hepatitis and cirrhosis. J Clin Microbiol 45:1058–1062

    Article  PubMed  Google Scholar 

  • Mulla ZD (2004) Treatment options in the management of necrotizing fasciitis caused by group A streptococcus. Expert Opin Pharmacother 5:1695–1700

    Article  PubMed  CAS  Google Scholar 

  • Nichols RL, Florman S (2001) Clinical presentation of soft-tissue infections and surgical site infections. Clin Infect Dis 33(suppl 2):S84–S93

    Article  PubMed  Google Scholar 

  • Norrby-Teglund A, Kaul RD, Low DE et al (1996) Plasma from patients with severe invasive group A streptococcal infections treated with normal polyspecific IgG inhibits streptococcal superantigen-induced T cell proliferation and cytokine production. J Immunol 156:3057–3064

    PubMed  CAS  Google Scholar 

  • Ogilvie CM, Miclau T (2006) Necrotizing soft tissue infections of the extremities and back. Clin Orthop Relat Res 447:179–186

    Article  PubMed  Google Scholar 

  • Pessa ME, Howard RJ (1985) Necrotizing fasciitis. Surg Gynecol Obstet 161:357–361

    PubMed  CAS  Google Scholar 

  • Rea WJ, Wyrick WJ (1970) Necrotizing fasciitis. Am J Surg 172:957–964

    CAS  Google Scholar 

  • Riefler J, Molavi A, Schwartz D, DiNubiule M (1988) Necrotizing fasciitis in adults due to group B Streptococcus. Arch Intern Med 148:727–729

    Article  PubMed  Google Scholar 

  • Rudge FW (1993) The role of hyperbaric oxygenation in the treatment of clostridial myonecrosis. Mil Med 158:80–83

    PubMed  CAS  Google Scholar 

  • Schwartzmann WA, Lambertus MW, Kennedy CA, Goetz MB (1991) Staphylococcal pyomyositis in patients infected by the human immunodeficiency virus. Am J Med 90:595–600

    Google Scholar 

  • Seal DV (2001) Necrotizing fasciitis. Curr Opin Infect Dis 14:127–132

    Article  PubMed  CAS  Google Scholar 

  • Singh G, Sinha SK, Adhikary S, Babu KS, Ray P, Khanna SK (2002) Necrotizing infections of soft tissues – a clinical profile. Eur J Surg 168:366–371

    Article  PubMed  Google Scholar 

  • Souyri C, Olivier P, Grolleau S, Lapeyre-Mestre M (2008) French Network of Pharmacovigilance Centres. Severe necrotizing soft-tissue infections and nonsteroidal anti-inflammatory drugs. Clin Exp Dermatol 33:249–255

    Article  PubMed  CAS  Google Scholar 

  • Stamenkovic I, Lew PD (1984) Early recognition of potentially fatal necrotizing fasciitis: the use of frozen-section biopsy. N Engl J Med 310:1689–1693

    Article  PubMed  CAS  Google Scholar 

  • Stevens DL (1992) Invasive group A streptococcus infections. Clin Infect Dis 14:2–11

    Article  PubMed  CAS  Google Scholar 

  • Stevens DL (1994) Invasive group A streptococcus infections: the past, present and future. Pediatr Infect Dis J 13:561–566

    PubMed  CAS  Google Scholar 

  • Stevens DL, Tanner MH, Winship J, Swarts RS, Ries KM, Schlievert PM, Kaplan E (1989) Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. N Engl J Med 321:1–13

    Article  PubMed  CAS  Google Scholar 

  • Taviloglu K, Cabioglu N, Cagatay A et al (2005) Idiopathic necrotizing fasciitis: risk factors and strategies for management. Am Surg 71:315–320

    PubMed  Google Scholar 

  • Theis JC, Rietveld J, Danesh-Clough T (2002) Severe necrotizing soft tissue infections in orthopaedic surgery. J Orthop Surg (Hong Kong) 10:108–113

    CAS  Google Scholar 

  • Tillou A, St Hill CR, Brown C, Velmahos G (2004) Necrotizing soft tissue infections: improved outcomes with modern care. Am Surg 70:841–844

    PubMed  Google Scholar 

  • Todd J, Fishaut M, Kaparal F, Welch T (1978) Toxic shock syndrome associated with phage-group I staphylococci. Lancet II:1116–1118

    Article  Google Scholar 

  • Urschel JD, Takita H, Antkowiak JG (1997) Necrotizing soft-tissue infections of the chest wall. Ann Thorac Surg 64:276–279

    Article  PubMed  CAS  Google Scholar 

  • Voros D (1997) Anaerobic infections of the soft tissue and bones. Anaerobe 3:117–119

    Article  PubMed  CAS  Google Scholar 

  • Wang KC, Shih CH (1992) Necrotizing fasciitis of the extremities. J Trauma 32:179–182

    Article  PubMed  CAS  Google Scholar 

  • Ward RG, Walsh MS (1991) Necrotizing fasciitis: 10 years’ experience in a district general hospital. Br J Surg 78:488–489

    Article  PubMed  CAS  Google Scholar 

  • Widjaja AB, Tran A, Cleland H, Leung M, Millar I (2005) The hospital costs of treating necrotizing fasciitis. ANZ J Surg 75:1059–1064

    Article  PubMed  Google Scholar 

  • Wilkinson D, Doolette D (2004) Hyperbaric oxygen treatment and survival from necrotizing soft tissue infection. Arch Surg 139:1339–1345

    Article  PubMed  Google Scholar 

  • Willoughby R, Greenberg RN (1983) The toxic shock syndrome and streptococcal pyrogenic exotoxins. Ann Intern Med 98:559

    Article  PubMed  CAS  Google Scholar 

  • Wilson B (1952) Necrotizing fasciitis. Am Surg 18:416–431

    PubMed  CAS  Google Scholar 

  • Wilson CB, Silber GR, O’Brien TF, Morgan AP (1976) Phycomycotic gangrenous cellulitis. Arch Surg 111:532–538

    Article  PubMed  CAS  Google Scholar 

  • Wong CH, Wang YS (2005) The diagnosis of necrotizing fasciitis. Curr Opin Infect Dis 18:101–106

    Article  PubMed  Google Scholar 

  • Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO (2003) Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am 85-A:1454–1460

    PubMed  Google Scholar 

  • Woodburn KR, Ramsay G, Gillespie G, Miller DF (1992) Retroperitoneal necrotizing fasciitis. Br J Surg 79:342–344

    Article  PubMed  CAS  Google Scholar 

  • Yamaoka M, Furusawa K, Uematsu T, Yasuda K (1994) Early evaluation of necrotizing fasciitis with use of CT. J Craniomaxillofac Surg 22:268–271

    Article  PubMed  CAS  Google Scholar 

  • Zumla A (1992) Superantigens, T cells and microbes. Clin Infect Dis 15:313–320

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. 14 Como Avenue, South Yarra, VIC, 3141, Australia

    Thomas Kossmann MD, FRACS, FAOrthoA & Cristina Morganti-Kossmann

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  1. Thomas Kossmann MD, FRACS, FAOrthoA
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  2. Cristina Morganti-Kossmann
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Correspondence to Thomas Kossmann MD, FRACS, FAOrthoA .

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Editors and Affiliations

  1. Dept. of Traumatology, Academic Teaching Hospital Celle, Celle, Germany

    Hans-Jörg Oestern

  2. University of Zurich Department of Trauma Surgery, Zürich, Switzerland

    Otmar Trentz

  3. Klinische Abt. Allgemeinchirurgie, Medizinische Universität Graz Universitätsklinik für Chirurgie, Graz, Austria

    Selman Uranues

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Kossmann, T., Morganti-Kossmann, C. (2014). Necrotizing Soft-Tissue Infections. In: Oestern, HJ., Trentz, O., Uranues, S. (eds) General Trauma Care and Related Aspects. European Manual of Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-88124-7_9

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  • DOI: https://doi.org/10.1007/978-3-540-88124-7_9

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