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K Zemplenyi, B Lopez, M Sardesai, J K Dillon
The progression of odontogenic infections to necrotizing soft tissue infections (NSTIs) is unknown. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is used to predict risk of NSTI. This study aimed to (1) estimate the frequency at which odontogenic infections progress to NSTIs, (2) measure the value of LRINEC in predicting progression to NSTI, and (3) estimate the charges associated with managing NSTIs. This retrospective cohort study enrolled all subjects admitted for the management of odontogenic infections from 2001 to 2013...
October 15, 2016: International Journal of Oral and Maxillofacial Surgery
Nikolai Siemens, Bhavya Chakrakodi, Srikanth Mairpady Shambat, Marina Morgan, Helena Bergsten, Ole Hyldegaard, Steinar Skrede, Per Arnell, Martin B Madsen, Linda Johansson, Julius Juarez, Lidija Bosnjak, Matthias Mörgelin, Mattias Svensson, Anna Norrby-Teglund
Necrotizing fasciitis caused by group A streptococcus (GAS) is a life-threatening, rapidly progressing infection. At present, biofilm is not recognized as a potential problem in GAS necrotizing soft tissue infections (NSTI), as it is typically linked to chronic infections or associated with foreign devices. Here, we present a case of a previously healthy male presenting with NSTI caused by GAS. The infection persisted over 24 days, and the surgeon documented the presence of a "thick layer biofilm" in the fascia...
July 7, 2016: JCI Insight
Stefan Walter Leichtle, Lily Tung, Moazzam Khan, Kenji Inaba, Demetrios Demetriades
BACKGROUND: The role of diagnostic imaging in suspected necrotizing soft tissue infections (NSTIs) is not clear owing to concerns about its value and possible delays in definitive surgical care. METHODS: Plain radiograph (XR) and computed tomography (CT) results of all patients who underwent operative debridement for a presumed NSTI from 2007 through 2014 at LAC + USC Medical Center were reviewed. Preoperative imaging was classified as being negative, suspicious (inflammatory changes), or diagnostic (soft tissue gas) for NSTI...
November 2016: Journal of Trauma and Acute Care Surgery
Martin Bruun Madsen, Theis Lange, Peter Buhl Hjortrup, Anders Perner
INTRODUCTION: Necrotising soft tissue infections (NSTI) are aggressive infections that can result in severe disability or death. Intravenous polyspecific immunoglobulin G (IVIG) is used as supplementary treatment for patients with NSTIs. The level of evidence is very low, but suggests that IVIG may have beneficial effects. However, IVIG may also have adverse effects. With this trial we will estimate the effects of IVIG on a patient-reported outcome and other patient-centred outcomes in patients with NSTI...
July 2016: Danish Medical Journal
Karthickeyan Chella Krishnan, Santhosh Mukundan, Jeyashree Alagarsamy, Junguk Hur, Suba Nookala, Nikolai Siemens, Mattias Svensson, Ole Hyldegaard, Anna Norrby-Teglund, Malak Kotb
Host genetic variations play an important role in several pathogenic diseases, and we have previously provided strong evidences that these genetic variations contribute significantly to differences in susceptibility and clinical outcomes of invasive Group A Streptococcus (GAS) infections, including sepsis and necrotizing soft tissue infections (NSTIs). Our initial studies with conventional mouse strains revealed that host genetic variations and sex differences play an important role in orchestrating the severity, susceptibility and outcomes of NSTIs...
July 2016: PLoS Pathogens
I Gassiep, J Douglas, E G Playford
Candida parapsilosis is an emerging pathogen worldwide. It commonly causes soft tissue infection; however, to our knowledge there has been no previous report of monomicrobial necrotizing soft tissue infection (NSTI) secondary to C. parapsilosis. We report the first case of NSTI caused by C. parapsilosis in an immunocompromised renal transplant patient, with the diagnosis proven both histologically and microbiologically. Our patient required aggressive surgical intervention and antifungal therapy, with postoperative survival at 90 days...
July 6, 2016: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Marco B Hansen, Lars S Rasmussen, Katrine Pilely, Dorthe Hellemann, Estrid Hein, Martin B Madsen, Ole Hyldegaard, Peter Garred
BACKGROUND: Mannose-binding lectin (MBL) and ficolins are pattern recognition molecules (PRMs) that play an important role during infection through activation of the lectin complement pathway. We assessed whether plasma PRM levels were associated with mortality in patients with necrotizing soft tissue infection (NSTI). METHODS: We conducted a prospective, observational study over 25 months involving 135 NSTI patients with a maximum follow-up of 2.7 years. Blood samples were taken upon admission...
2016: Journal of Innate Immunity
Desiree Gregg, Lynn Hiller, Peter Fabri
Necrotizing soft tissue injury (NSTI) is rare with an impressively difficult and dangerous clinical course. While the importance of nutrition as part of the treatment plan for NSTI is recognized as essential to recovery, specific recommendations have not been elucidated. A review of the evidence-based guidelines and published research to accomplish wound healing is presented. The nutrition considerations in the setting of organ failure are also discussed. This article outlines a complicated case of a septic, malnourished man with Fournier's gangrene and acute kidney injury...
June 13, 2016: Nutrition in Clinical Practice
Luke R Putnam, Morgan K Richards, Brinkley K Sandvall, Richard A Hopper, John H T Waldhausen, Matthew T Harting
BACKGROUND/PURPOSE: Optimal outcomes for necrotizing soft tissue infections (NSTI) depend on rapid diagnosis and management. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is a validated diagnostic tool for adult NSTI, but its value for children remains unknown. We hypothesized that modification of the LRINEC score may increase its diagnostic accuracy for pediatric NSTI. METHODS: We performed a case-control study of pediatric patients (age <18) with NSTI (cases) and patients with severe soft tissue infections prompting surgical consultation (controls)...
June 2016: Journal of Pediatric Surgery
Marco Bo Hansen, Lars Simon Rasmussen, Peter Garred, Daniel Bidstrup, Martin Bruun Madsen, Ole Hyldegaard
BACKGROUND: New biomarkers are needed to assess the severity of necrotizing soft tissue infection (NSTI) at an early stage and to individualize treatment strategies. We assessed pentraxin-3 (PTX3) as a marker of disease severity and risk of death in patients with NSTI. METHODS: We conducted a prospective, observational study in the intensive care unit at Copenhagen University Hospital, where treatment of NSTI is centralized at a national level. We compared PTX3, procalcitonin and C-reactive protein in septic shock versus nonshock patients and in amputated versus nonamputated patients using the Mann-Whitney U test...
2016: Critical Care: the Official Journal of the Critical Care Forum
Hideharu Hagiya, Masahiro Ojima, Takeshi Yoshida, Takahiro Matsui, Eiichi Morii, Kazuaki Sato, Shinichiro Tahara, Hisao Yoshida, Kazunori Tomono
A 64-year-old man with advanced liver cirrhosis was transferred to an emergency center due to septic shock and markedly inflamed left leg. Under a clinical diagnosis of necrotizing soft tissue infection (NSTI), the patient undertook intensive therapy but died 25 h after arrival. The pathogenic organism, Serratia marcescens, was later isolated from blood and soft tissue cultures. NSTI is very rarely associated with S. marcescens. A literature review showed that only 16 such cases, including our case, have been reported to date...
May 2016: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Camille Hua, Emilie Sbidian, Francois Hemery, Jean Winoc Decousser, Romain Bosc, Roland Amathieu, Alain Rahmouni, Pierre Wolkenstein, Laurence Valeyrie-Allanore, Christian Brun-Buisson, Nicolas de Prost, Olivier Chosidow
BACKGROUND: Necrotizing soft-tissue infection (NSTI) is uncommon but life-threatening. A recent meta-analysis estimated the overall mortality at 23.5%. OBJECTIVE: We sought to identify risk factors associated with mortality in a cohort of patients with NSTI in a tertiary care center. METHODS: We identified 512 patients with NSTI between 1996 and 2012 in the national hospital database Program for Medicalization of Information Systems and examined risk factors of mortality with NSTI by univariate and multivariate analysis...
December 2015: Journal of the American Academy of Dermatology
Eileen M Bulger, Addison May, Andrew Bernard, Stephen Cohn, David C Evans, Sharon Henry, Jacob Quick, Leslie Kobayashi, Kevin Foster, Therese M Duane, Robert G Sawyer, John A Kellum, Adrian Maung, Greg Maislin, David D Smith, Irit Segalovich, Wayne Dankner, Anat Shirvan
BACKGROUND: Necrotizing soft tissue infections (NSTI) represent a rare but devastating disease for which the systemic manifestations have been poorly characterized. In an effort to define an optimal endpoint for clinical trials in this condition, the objective of this study was to establish the pattern of organ dysfunction over time and determine the correlation between organ dysfunction and clinical outcome in patients with NSTI. METHODS: We conducted a multicenter, retrospective clinical study of patients with NSTI presenting to 12 academic medical centers in the U...
December 2015: Surgical Infections
Samantha A Moore, Brandon H Levy, Chalani Prematilake, Sharmila Dissanaike
BACKGROUND: Our study sought to identify independent risk factors predisposing patients with necrotizing soft tissue infections (NSTIs) to mortality from among laboratory values, demographic data, and microbiologic findings in a small population. To this end, a retrospective review was conducted of the medical records of all patients with NSTI who had been treated at our institution from 2003 to 2012 (n=134). METHODS: Baseline demographics and comorbidities, clinical and laboratory values, hospital course, and the microbiologic characteristics of surgical incision cultures were recorded...
December 2015: Surgical Infections
Christian Eckmann, Wolfgang Heizmann, Klaus-Friedrich Bodmann, Christoph von Eiff, Christian Petrik, Peter-Andreas Loeschmann
BACKGROUND: Necrotizing skin and soft tissue infections (NSTI) form a group of aggressive diseases that require radical debridement for infection control. Simultaneously, a high-dose broad spectrum antibiotic regimen needs to be initiated with control of septic complications in the intensive care setting. The aim of this work is to analyze the efficacy and safety of tigecycline in a subpopulation of hospitalized, severely ill surgical NSTI patients who were documented in a large multicenter non-interventional study on tigecycline use in routine clinical practice...
October 2015: Surgical Infections
Rhett N Willis, Christopher A Guidry, Christopher B Horn, Daniel Gilsdorf, Stephen W Davies, Zachary C Dietch, Robert G Sawyer
BACKGROUND: Broad-spectrum antibiotic therapy is critical in the management of necrotizing soft tissue infections (NSTI) in the emergency setting. Clindamycin often is included empirically to cover monomicrobial gram-positive pathogens but probably is of little value for polymicrobial infections and is associated with significant side effects, including the induction of Clostridium difficile colitis. However, there have been no studies predicting monomicrobial infections prior to obtaining cultures...
October 2015: Surgical Infections
Marco Bo Hansen, Ulf Simonsen, Peter Garred, Ole Hyldegaard
INTRODUCTION: The mortality and amputation rates are still high in patients with necrotising soft tissue infections (NSTIs). It would be ideal to have a set of biomarkers that enables the clinician to identify high-risk patients with NSTI on admission. The objectives of this study are to evaluate inflammatory and vasoactive biomarkers as prognostic markers of severity and mortality in patients with NSTI and to investigate whether hyperbaric oxygen treatment (HBOT) is able to modulate these biomarkers...
2015: BMJ Open
Masashi Mimura, Mari Ueki, Hidehiro Oku, Bunpei Sato, Tsunehiko Ikeda
PURPOSE: To study the indications for and effectiveness of Nunchaku-style silicone tube intubation (NSTI) in treating primary acquired lacrimal drainage obstruction (PALDO). METHODS: In this interventional cohort study, 235 consecutive patients in 1 institution who had complete lacrimal obstruction were investigated. Of those, 212 PALDO patients were enrolled, and 156 of the PALDO patients ultimately satisfied our treatment protocol and were then followed up for 12 months postsurgery...
July 2015: Japanese Journal of Ophthalmology
D Mittapalli, R Velineni, N Rae, A Howd, S A Suttie
OBJECTIVE: To assess the short and long-term outcomes of necrotizing soft tissue infection (NSTI) in intravenous drug users (IVDU) in a regional vascular centre. METHODS: This was a retrospective analysis of all IVDUs with NSTI admitted to the regional vascular surgical unit between January 2009 and July 2014. Clinical outcome measures were interval between admission and surgery, length of ITU/HDU and hospital stays, post-operative complications, in hospital and one year mortality...
May 2015: European Journal of Vascular and Endovascular Surgery
Carly R Richards, Margaret E Clark, Donnell K Bowen, Denise Uratake, Farhan Ayubi, Tony Katras, Dwight C Kellicut
BACKGROUND: Necrotizing soft tissue infection (NSTI), formerly referred to as necrotizing fasciitis, is a rare but serious postoperative complication. NSTI following arterial bypass is seen only once in the literature (for a coronary artery bypass) and is not mentioned following peripheral bypass. Although surgical site infections have been studied extensively, there are limited published data on postoperative NSTI and no data for NSTI following peripheral arterial bypass. CASE PRESENTATION: Here we present the first, to our knowledge, reported instance of an NSTI following a lower extremity peripheral bypass...
2015: Annals of Vascular Surgery
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