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Managing Necrotizing Soft Tissue Infections: Polymicrobial Soft Tissue ...

Source: www.facs.org
Topic: Soft Tissue
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Sort Desciption: Necrotizing Soft Tissue. Infections. A spectrum of ... tissues, fascia, and muscle. Classification of NSTI. Cellulitis. Fasciitis. Myonecrosis ...

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Soft Tissue Infections A spectrum of diseases characterized by extensive, rapidly progressive necrosis which can involve the skin, subcutaneous tissues, fascia, and muscle Classification of NSTI Cellulitis Fasciitis Myonecrosis Cellulitis ClostridialC. perfringens Non-clostridialgram negative bacteria and anaerobes Cellulitis ClostridialC. perfringens Non-clostridialgram negative bacteria and anaerobes S. aureus S. pyogenes H. influenzaechildren; HIV+ S. pneumoniaediabetics; immunosuppression P. multocidaanimal bites A. hydrophilia V. vulnificus Myonecrosis ClostridialC. perfringens C. histolyticum C. septicum Non-clostridalanaerobes Enterobacteriaceae S. pyogenes Pathophysiology of Necrotizing Fasciitis Byproducts of bacteria result in tissue invasion due to vascular thrombosis Monomicrobial (25%) S. pyogenes C. perfringens S. aureus P. aeruginosa S. pneumoniae V. vulnificus Polymicrobial Necrotizing Fasciitis (75%) Aerobes/facultatives S. pyogenes E. coli enterococci S. viridans staphylococci P. mirabilis Klebsiella P. aeruginosa Anaerobes Bacteroides Peptostreptococci C. perfringens Anatomic Sites Extremities Abdominal wall Perineum Any body region is susceptible Predisposing Factors Unrecognized or inadequately treated infectionscutaneous; perineal Bites IV drug abuse Contaminated operation Soft tissue injury Idiopathic Necrotizing Fasciitis 10-15% of cases Microbiology = monomicrobial S. pyogenes in >50% Extremity involvement supervenes Little difference in outcome Factors predisposing to NSTI Obesity Diabetes mellitus Smoking Malnutrition Peripheral vascular disease Alcoholism IV drug abuse Diagnostic findings Edema Pain Erythema Tenderness Foul discharge Induration Crepitus Bullous lesion Necrosis Diagnostic Findings Soft tissue gas75% Abnormal ...

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