Necrotizing fasciitis: an update on epidemiology, diagnostic methods, and treatment.

IF 3.6 3区医学 Q2 INFECTIOUS DISEASES

Current Opinion in Infectious Diseases Pub Date : 2024-04-01 Epub Date: 2023-11-30 DOI:10.1097/QCO.0000000000000988

Fatima Allaw, Saliba Wehbe, Souha S Kanj

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引用次数: 0

Abstract

Purpose of review: The aim of this review is to discuss the latest evidence of epidemiology, diagnostic methods, and treatment of necrotizing soft tissue infections (NSTIs) with a particular focus on necrotizing fasciitis (NF).

Recent findings: NSTIs have been historically referred to as NF but encompass a broader range of infections, with variable rates ranging from 0.86 to 32.64 per 100 000 person-years, influenced by factors such as climate and seasonal variations. They have diverse microbiological profiles categorized into different types based on the involved pathogens, including polymicrobial or monomicrobial infections caused by organisms such as group A streptococcus (GAS), Staphylococcus aureus , some Gram-negative pathogens, and filamentous fungi following trauma and natural disasters. Diagnosis relies on clinical symptoms and signs, laboratory markers, and imaging. However, the gold standard for diagnosis remains intraoperative tissue culture. Treatment involves repeated surgical debridement of necrotic tissues in addition to intravenous antibiotics. Adjuvant therapies with intravenous immunoglobulin (IVIG) and hyperbaric oxygen therapy (HBOT) might have a role. Soft tissue reconstruction may be necessary following surgery.

Summary: Prompt diagnosis and proper medical and surgical management of NSTI will improve outcomes.

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坏死性筋膜炎:流行病学、诊断方法和治疗的最新进展。

综述目的:本综述的目的是讨论坏死性软组织感染(NSTIs)的流行病学，诊断方法和治疗的最新证据，特别是坏死性筋膜炎(NF)。最近的发现:NSTIs在历史上被称为NF，但包括更广泛的感染范围，受气候和季节变化等因素的影响，发病率从每10万人年0.86至32.64不等。它们具有不同的微生物特征，根据所涉及的病原体分为不同的类型，包括由生物体引起的多微生物或单微生物感染，如A群链球菌(GAS)、金黄色葡萄球菌、一些革兰氏阴性病原体和创伤和自然灾害后的丝状真菌。诊断依赖于临床症状和体征、实验室标记物和影像学。然而，诊断的金标准仍然是术中组织培养。除静脉注射抗生素外，治疗包括反复手术清理坏死组织。静脉注射免疫球蛋白(IVIG)和高压氧治疗(HBOT)的辅助治疗可能有一定作用。手术后可能需要软组织重建。总结:NSTI的及时诊断和适当的内科和外科治疗将改善预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Infectious Diseases 医学-传染病学

CiteScore

6.70

自引率

2.60%

发文量

121

审稿时长

6-12 weeks

期刊介绍： This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on two topics, every issue of Current Opinion in Infectious Disease delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as HIV infection and AIDS; skin and soft tissue infections; respiratory infections; paediatric and neonatal infections; gastrointestinal infections; tropical and travel-associated diseases; and antimicrobial agents.