Necrotizing Soft Tissue Infections

Daniel Mathieu, Raphaël Favory, Jean-François Cesari, Francis Wattel

Service d'Urgence Respiratoire, de Réanimation Médicale et de Médecine Hyperbare, Hôpital Calmette, Centre Hospitalier et Universitaire, Lille, France

Abstract: Anaerobic soft tissue infections are still life-threatening infections. Even if uncommon nowadays, they remain severe conditions because often associated with major systemic effects leading to patient death if not promptly recognized and aggressively treated. Their origins are often traumatic or surgical but they can also develop from an ulcer or a small wound in patients at risk (i.e. diabetics, patients with peripheral vascular disease, etc). Hypoxia, traumatic muscle injury, heavy bacterial contamination as well as errors in antibiotic prophylaxis are major causes. Treatment includes antibiotic therapy adapted to both the anaerobic and associated aerobic bacteria; early and extensive surgical debridement; and intensive Hyperbaric Oxygen Therapy (HBO). Unfortunately, physicians are insufficiently aware of the first sign of these infections which explains why the management is often inadequate initially. Strict preventive measures must be taken to avoid their occurrence

Keywords: Anaerobic bacteria, anaerobic infections (soft tissue), gas gangrene, necrotizing fasciitis, Fournier gangrene, Ludwig angina, bacterial synergy

Anaerobic soft tissue infections are still life-threatening infections. Even if uncommon nowadays, they remain severe conditions because often associated with major systemic complications. Once established, they usually progress rapidly toward patient death unless promptly recognized and aggressively treated. Unfortunately, physicians are insufficiently aware of the initial presentation which explains why the management is often inadequate in the early phases.

Current points of interest include classification, pathophysiology and its implications on prevention, and function-sparing therapy (i.e., limb salvage).

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