ABSTRACT
Objective: To evaluate the clinical efficacy of damage control surgery (DCS) in the treatment of odontogenic cervical Necrotizing Fasciitis (CNF) complicated with septic shock. Methods: From January 2019 to January 2022, 8 cases with odontogenic cervical Necrotizing Fasciitis (CNF) complicated with septic shock were selected. According to the concept of damage control surgery (DCS), they were treated with incision and decompression, debridement and sealing vacuum suction (VSD) at the early stage, anti-shock, anti-infection, life support. At the later stage, the patients were treated by skin autograft combined with early rehabilitation. Results: In 8 cases, shock was corrected in a short time, lac decreased rapidly, infection index including white blood cell (WBC), C-reactive protein (CRP), thrombocytocrit (PCT) decreased rapidly, organ function including blood urea nitrogen (BUN), total bilirubin (Tbil), Aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (Alb), creatine kinase (CK) was improved effectively, P < .05. The wounds of all the patients were effectively closed and cured. The average days of hospitalization were 21-42 days (27.00±3.20 days). No recurrence was found in the follow-up of 6 months. Conclusion: Odontogenic cervical Necrotizing fasciitis with septic shock progresses rapidly. Damage control surgery can effectively control infection, correct shock and avoid further deterioration of organ function. This scheme has unique advantages, which can make the wound repaired in time and improve the success rate of treatment. It is worth popularizing in clinic.
ABSTRACT
Background: Community-acquired pneumonia (CAP) is an extraordinarily heterogeneous illness, both in the range of responsible pathogens and the host response. Metagenomic next-generation sequencing (mNGS) is a promising technology for pathogen detection. However, the clinical application of mNGS for pathogen detection remains challenging. Methods: A total of 205 patients with CAP admitted to the intensive care unit were recruited, and broncho alveolar lavage fluids (BALFs) from 83 patients, sputum samples from 33 cases, and blood from 89 cases were collected for pathogen detection by mNGS. At the same time, multiple samples of each patient were tested by culture. The diagnostic performance was compared between mNGS and culture for pathogen detection. Results: The positive rate of pathogen detection by mNGS in BALF and sputum samples was 89.2% and 97.0%, which was significantly higher (P < 0.001) than that (67.4%) of blood samples. The positive rate of mNGS was significantly higher than that of culture (81.0% vs. 56.1%, P = 1.052e-07). A group of pathogens including Mycobacterium abscessus, Chlamydia psittaci, Pneumocystis jirovecii, Orientia tsutsugamushi, and all viruses were only detected by mNGS. Based on mNGS results, Escherichia coli was the most common pathogen (15/61, 24.59%) of non-severe patients with CAP, and Mycobacterium tuberculosis was the most common pathogen (21/144, 14.58%) leading to severe pneumonia. Pneumocystis jirovecii was the most common pathogen (26.09%) in severe CAP patients with an immunocompromised status, which was all detected by mNGS only. Conclusion: mNGS has higher overall sensitivity for pathogen detection than culture, BALF, and sputum mNGS are more sensitive than blood mNGS. mNGS is a necessary supplement of conventional microbiological tests for the pathogen detection of pulmonary infection.