RESUMEN
Diagnostic and therapeutic priorities vary for the 8 types of infection reviewed.
Asunto(s)
Antibacterianos/administración & dosificación , Celulitis (Flemón)/tratamiento farmacológico , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Antibacterianos/farmacología , Celulitis (Flemón)/fisiopatología , Humanos , Infecciones de los Tejidos Blandos/fisiopatologíaRESUMEN
Background: Necrotizing fasciitis is a major health problem throughout the world. The purpose of this review is to assist providers with the care of these patients through a better understanding of the pathophysiology and management options. Methods: This is a collaborative review of the literature between members of the Surgical Infection Society of North America and World Society of Emergency Surgery. Results: Necrotizing fasciitis continues to be difficult to manage with the mainstay being early diagnosis and surgical intervention. Recognition of at-risk populations assists with the initiation of treatment, thereby impacting outcomes. Conclusions: Although there are some additional treatment strategies available, surgical debridement and antimicrobial therapy are central to the successful eradication of the disease process.
Asunto(s)
Fascitis Necrotizante/fisiopatología , Fascitis Necrotizante/terapia , Infecciones de los Tejidos Blandos/terapia , Antibacterianos/uso terapéutico , Infecciones por Clostridium/fisiopatología , Infecciones por Clostridium/terapia , Desbridamiento/métodos , Fascitis Necrotizante/sangre , Fascitis Necrotizante/diagnóstico , Humanos , Medición de Riesgo , Factores de Riesgo , Infecciones de los Tejidos Blandos/sangre , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones de los Tejidos Blandos/fisiopatología , Infecciones Estafilocócicas/fisiopatología , Infecciones Estafilocócicas/terapia , Staphylococcus aureus , Infecciones Estreptocócicas/fisiopatología , Infecciones Estreptocócicas/terapia , Streptococcus pyogenesRESUMEN
OBJECTIVE: To describe the epidemiology, critical care resource use of and outcomes from an intensive care admission for a skin or soft tissue infection in Central Australia. DESIGN: Retrospective database review of prospectively collected data identifying all patients requiring admission for a life-threatening illness related to a skin or soft tissue infection. SETTING: Intensive care unit Alice Springs Hospital. PARTICIPANTS: All patients admitted with a primary diagnosis of skin or soft tissue infection between 2010 and 2016. MAIN OUTCOME MEASURE: Annualised incidence of skin or soft tissue infection requiring intensive care. Secondary outcomes examined resource use (length of stay, mechanical ventilation) and a description of the microbiology of skin or soft tissue infection in Central Australia. RESULTS: There were 80 admissions to the intensive care unit over the sampling period, yielding an annualised incidence of 24.2 intensive care unit admissions per 100 000 population. Eighty-five per cent were Indigenous with high rates of co-morbid disease including poorly controlled type 2 diabetes, haemodialysis-dependent chronic kidney disease and co-infection with human T-cell lymphocytic virus. The predominant type of skin or soft tissue infection was abscess, predominantly below the waist. Gram-positive cocci comprised 50% of the organisms cultured, and 20% of organisms were multi-resistant. Mortality was 0% and 1.3% at 28 and 90 days respectively. CONCLUSION: The annualised incidence of skin or soft tissue infection requiring intensive care support in Central Australia is higher than expected. This probably reflects the high burden of chronic disease and poor living conditions. While there is no mortality burden associated with skin or soft tissue infection in Central Australia, there is substantial morbidity. The data from this study adds weight to the call for improved primary health resources for this group.
Asunto(s)
Cuidados Críticos , Hospitales Rurales , Infecciones de los Tejidos Blandos , Adulto , Bases de Datos Factuales , Femenino , Costos de la Atención en Salud , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Northern Territory/epidemiología , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , Infecciones de los Tejidos Blandos/clasificación , Infecciones de los Tejidos Blandos/epidemiología , Infecciones de los Tejidos Blandos/fisiopatologíaRESUMEN
Em 1992, a Organização Mundial da Saúde (OMS) propôs a seguinte definição: Sepse puerperal é uma infecção do trato genital ocorrendo, em qualquer momento, entre a ruptura das membranas ou o trabalho e o 42º dia após o parto, no qual estão presentes dois ou mais dos seguintes eventos: ⢠Dor pélvica; ⢠Febre (temperatura oral de 38,5 °C ou superior em qualquer ocasião); ⢠Corrimento vaginal anormal, por exemplo, presença de pus; ⢠Cheiro anormal/mau cheiro do corrimento vaginal; ⢠Atraso na redução do tamanho do útero (<2 cm/dia durante os primeiros oito dias). 1. O conceito de infecção puerperal deve ser complementado com o de morbidade febril puerperal, pela dificuldade de caracterizar a infecção que ocorre logo após o parto. 2. Outras definições que se fazem necessárias são: ⢠Bacteremia: presença de bactérias na corrente sanguínea; ⢠Sepse: síndrome clínica caracterizada pela resposta da hospedeira a um processo infeccioso, acompanhada de uma resposta inflamatória sistêmica; ⢠Sepse grave: sepse associada à disfunção de um ou mais órgãos (sistema nervoso central, renal, pulmonar, hepática, cardíaca, coagulopatia, acidose metabólica); ⢠Choque séptico: sepse com hipotensão refratária à ressuscitação volêmica. 3. A OMS incluiu o termo "infecção puerperal", pois hoje estão morrendo mulheres com infecções de outros locais do corpo.
Asunto(s)
Humanos , Femenino , Embarazo , Complicaciones del Embarazo/epidemiología , Infección Puerperal/prevención & control , Neumonía , Choque Séptico , Piel/fisiopatología , Enfermedades Urológicas , Factores de Riesgo , Bacteriemia , Dolor Pélvico , Infecciones de los Tejidos Blandos/fisiopatología , Sepsis/fisiopatología , Mastitis/fisiopatologíaRESUMEN
Bladder outlet obstruction is a common aetiology of lower urinary tract symptoms in adult men and several treatment options are available. We report on a case of a 73-year-old man with a complicated soft tissue infection due to an urinoma after laser prostatectomy. He was treated by several surgical interventions and long-term antibiotic therapy.
Asunto(s)
Antibacterianos/administración & dosificación , Terapia por Láser , Complicaciones Posoperatorias , Próstata , Infecciones de los Tejidos Blandos , Obstrucción del Cuello de la Vejiga Urinaria , Urinoma , Anciano , Fasciotomía/métodos , Humanos , Terapia por Láser/efectos adversos , Terapia por Láser/métodos , Masculino , Tamaño de los Órganos , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/terapia , Próstata/patología , Próstata/cirugía , Enfermedades de la Próstata/complicaciones , Enfermedades de la Próstata/cirugía , Reoperación/métodos , Infecciones de los Tejidos Blandos/etiología , Infecciones de los Tejidos Blandos/fisiopatología , Infecciones de los Tejidos Blandos/terapia , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Obstrucción del Cuello de la Vejiga Urinaria/fisiopatología , Obstrucción del Cuello de la Vejiga Urinaria/cirugía , Fístula Urinaria/complicaciones , Fístula Urinaria/terapia , Urinoma/complicaciones , Urinoma/fisiopatologíaRESUMEN
INTRODUCTION: An early-stage decision clinicians often make in the management of complex wounds is which method of wound preparation will be appropriate for the patient. This decision can be affected by numerous wound and patient risk factors that present challenges and may make surgical debridement difficult in patients with complex wounds. Recently, negative pressure wound therapy with instillation and dwell time (NPWTi-d) using a novel reticulated open-cell foam dressing with through holes (ROCF-CC) was shown to aid in the loosening and removal of thick exudate and nonviable tissue from wounds. OBJECTIVE: The authors present their experiences of using NPWTi-d with ROCF-CC, along with rationales for wound care decisions. MATERIALS AND METHODS: Patients received antibiotics and surgical debridement when appropriate. Therapy selection and parameters were based on a decision-tree model for wound care management that takes into consideration patient and wound information. Most patients received NPWTi-d with ROCF-CC for a duration of 5 to 8 days; however, 1 patient received NPWTi-d with ROCF-CC for more than 30 days due to the wound extent and severity. Therapy consisted of instilling saline or quarter-strength sodium hypochlorite solution with dwell times of 3 to 10 minutes, followed by 2 hours or 3.5 hours of NPWT either at -100 mm Hg or -125 mm Hg. RESULTS: There were 6 patients (3 men, 3 women; average age, 58.5 years) treated. Wound types included 3 pressure ulcers, 1 necrotizing soft tissue infection, 1 perianal abscess, and 1 large abdominal wound. Patient comorbidities included obesity, type 2 diabetes, and radiation therapy. In all cases, progression of wound healing was observed with no complications. This method produced viable granulation tissue and wound bed preparation; however, patients were not followed to closure or grafting. CONCLUSIONS: These cases help support the use of NPWTi-d with ROCF-CC as a viable option for wound care providers in the early-stage management of complex wounds.
Asunto(s)
Enfermedad Crítica/terapia , Terapia de Presión Negativa para Heridas/métodos , Cicatrización de Heridas/fisiología , Absceso Abdominal/fisiopatología , Absceso Abdominal/terapia , Enfermedades del Ano/fisiopatología , Enfermedades del Ano/terapia , Vendajes , Cuidados Críticos/métodos , Desinfectantes/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Úlcera por Presión/fisiopatología , Úlcera por Presión/terapia , Solución Salina/administración & dosificación , Hipoclorito de Sodio/administración & dosificación , Infecciones de los Tejidos Blandos/fisiopatología , Infecciones de los Tejidos Blandos/terapia , Resultado del TratamientoRESUMEN
GENERAL PURPOSE: To explore skin and soft-tissue infections and vascular damage in persons who inject drugs and relate these changes to wound development and care. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Review the issues surrounding wound infections in persons who inject drugs.2. Describe the risk factors and manifestations of wound infections in persons who inject drugs.3. Summarize the treatment options for wound infections in persons who inject drugs. ABSTRACT: The number of persons who inject drugs (PWIDs) is increasing. The literature has placed a substantial focus on the association between injection drug use and the transmission of blood-borne viral infections such as HIV and hepatitis C, but there is less extant research on other injuries such as skin and soft tissue infections (SSTIs), vascular damage, and associated wounds. Both SSTIs and vascular injury can result in marked morbidity and mortality and wounds that are slow to heal, likely to reoccur, and lifelong. The aims of this article are to (1) explore SSTIs and vascular damage in PWIDs and (2) relate these changes to wound development and care. Providers must address the health and psychosocial problems of PWIDs; take physical, psychosocial, and substance use histories; and develop multifocal plans of care. Finally, care must be provided in a nonjudgmental manner.
Asunto(s)
Cuidados de la Piel/métodos , Infecciones de los Tejidos Blandos/etiología , Abuso de Sustancias por Vía Intravenosa/terapia , Enfermedades Vasculares/etiología , Heridas y Lesiones/etiología , Heridas y Lesiones/terapia , Educación Médica Continua , Femenino , Humanos , Masculino , Infecciones de los Tejidos Blandos/fisiopatología , Infecciones de los Tejidos Blandos/terapia , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/epidemiología , Enfermedades Vasculares/terapia , Infección de Heridas/etiología , Infección de Heridas/terapiaRESUMEN
PURPOSE: The purpose was to determine significant predictors of treatment failure of skin and soft tissue infections (SSTI) in the inpatient and outpatient setting. METHODS: A retrospective chart review of patients treated between January 1, 2005 to July 1, 2016 with ICD-9 or ICD-10 code of cellulitis or abscess. The primary outcome was failure defined as an additional prescription or subsequent hospital admission within 30â¯days of treatment. Risk factors for failure were identified through multivariate logistic regression. RESULTS: A total of 541 patients were included. Seventeen percent failed treatment. In the outpatient group, 24% failed treatment compared to 9% for inpatients. Overweight/obesity (body mass index (BMI)â¯>â¯25â¯kg/m2) was identified in 80%, with 15% having a BMI >40â¯kg/m2. BMI, heart failure, and outpatient treatment were determined to be significant predictors of failure. The unit odds ratio for failure with BMI was 1.04 (95% [Cl]â¯=â¯1.01 to 1.1, pâ¯=â¯0.0042). Heart failure increased odds by 2.48 (95% [Cl]â¯=â¯1.3 to 4.7, pâ¯=â¯0.0056). Outpatients were more likely to fail with an odds ratio of 3.36. CONCLUSION: Patients with an elevated BMI and heart failure were found to have increased odds of failure with treatment for SSTIs. However, inpatients had considerably less risk of failure than outpatients. These risk factors are important to note when making the decision whether to admit a patient who presents with SSTI in the emergency department. Thoughtful strategies are needed with this at-risk population to prevent subsequent admission.
Asunto(s)
Antibacterianos/uso terapéutico , Enfermedades Cutáneas Infecciosas/fisiopatología , Infecciones de los Tejidos Blandos/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Comorbilidad , Servicio de Urgencia en Hospital , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Enfermedades Cutáneas Infecciosas/tratamiento farmacológico , Enfermedades Cutáneas Infecciosas/epidemiología , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Infecciones de los Tejidos Blandos/epidemiología , Insuficiencia del Tratamiento , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Acute bacterial skin and skin structure infections (ABSSSI) is a common cause of acute admissions worldwide, but the disease is not well understood epidemiologically with respect to factors that determine positive blood cultures or patient mortality. To understand the utility of blood cultures and the association between bacteremia and mortality in patients with ABSSSI, we conducted a retrospective study to investigate factors associated with positive blood cultures and mortality in patients with ABSSSI. A retrospective cohort study of hospitalized adult patients with ABSSSI was conducted in a tertiary hospital in Taiwan between March 2015 and December 2016. A total of 1322 hospitalized patients with ABSSSI are included. The overall mortality rate is 2.1% (28/1322), and 122 patients had positive blood culture results. Comorbidities that are significant risk factors for a positive blood culture include diabetes mellitus and chronic kidney disease. Significant risk factors evident in laboratory evaluations include high C-reactive protein (CRP) level (> 20 mg/dL), hyperglycemia, and hypoalbuminemia. Bacteremia is also a significant factor associated with mortality. A blood culture should be considered for patients with ABSSSI with diabetes mellitus or chronic kidney disease or those exhibiting abnormal CRP, glucose, or albumin levels because of the positive correlation between bacteremia and mortality.
Asunto(s)
Bacteriemia/fisiopatología , Infecciones de los Tejidos Blandos/complicaciones , Anciano , Anciano de 80 o más Años , Bacteriemia/epidemiología , Bacteriemia/mortalidad , Proteína C-Reactiva/análisis , Distribución de Chi-Cuadrado , Femenino , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Infecciones de los Tejidos Blandos/epidemiología , Infecciones de los Tejidos Blandos/fisiopatología , Taiwán/epidemiologíaRESUMEN
PURPOSE: Severe necrotizing soft-tissue infections (NSTIs) require immediate early surgical treatment to avoid adverse outcomes. This study aims to determine the impact of early surgery and comorbid conditions on the outcomes of NSTIs. METHODS: A retrospective cohort study was performed on all subjects presenting with NSTI at an academic medical center between 2005 and 2016. Patients were identified based on ICD codes. Those under the age of 18 or with intraoperative findings not consistent with NSTI diagnosis were excluded. RESULTS: There were 115 patients with a confirmed diagnosis of NSTI with a mean age of 55 ± 18 years; 41% were females and 55% were diabetics. Thirty percent of patients underwent early surgery (< 6 h). There were no significant differences between groups in baseline characteristics. The late group (≥ 6 h) had prolonged hospital stay (38 vs. 23 days, p < 0.008) in comparison to the early group (< 6 h). With every 1 h delay in time to surgery, there is a 0.268 day increase in length of stay, adjusted for these other variables: alcohol abuse, number of debridements, peripheral vascular disease, previous infection and clinical necrosis. Mortality was 16.5%. Multivariable analysis revealed that alcohol abuse, peripheral vascular disease, diabetes, obesity, hypothyroidism, and presence of COPD were associated with an increase in mortality. CONCLUSIONS: Early surgical intervention in patients with severe necrotizing soft-tissue infections reduces length of hospital stay. Presence of comorbid conditions such as alcohol abuse, peripheral vascular disease, diabetes, obesity and hypothyroidism were associated with increased mortality.
Asunto(s)
Desbridamiento/métodos , Fascitis Necrotizante/cirugía , Infecciones de los Tejidos Blandos/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Anciano , Comorbilidad , Fascitis Necrotizante/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Infecciones de los Tejidos Blandos/fisiopatología , Resultado del TratamientoRESUMEN
INTRODUCTION: Any alteration or impairment to normal wound healing can result in the development of chronic wounds, which may lead to serious complications such as infection and loss of body fluid and proteins. Primary closure alone may not be sufficient to fulfill the criteria of successful defect reconstruction. Therefore, additional procedures such as skin grafting must be considered as an option. CASE REPORT: The case of a 43-year-old woman with diabetes who was admitted to the University Hospital Rebro (Zagreb, Croatia) due to an infected, nonhealing wound on her left foot. Skin grafts combined with negative pressure wound therapy (NPWT) before and after graft application improved wound healing in this patient. CONCLUSIONS: In this patient, the combination of skin grafts with NPWT before and after graft application reduced the comorbidities and complications often seen in the diabetic patient population. Herein, the authors utilized a quicker, cost-efficient, and safer technique of wound closure compared with traditional nonsurgical methods.
Asunto(s)
Artropatía Neurógena/fisiopatología , Pie Diabético/fisiopatología , Terapia de Presión Negativa para Heridas , Procedimientos de Cirugía Plástica/métodos , Trasplante de Piel , Infecciones de los Tejidos Blandos/fisiopatología , Cicatrización de Heridas/fisiología , Adulto , Antibacterianos/uso terapéutico , Artropatía Neurógena/microbiología , Artropatía Neurógena/terapia , Terapia Combinada , Pie Diabético/microbiología , Pie Diabético/terapia , Femenino , Humanos , Infecciones de los Tejidos Blandos/microbiología , Infecciones de los Tejidos Blandos/terapia , Colgajos Quirúrgicos/irrigación sanguínea , Resultado del TratamientoRESUMEN
BACKGROUND: Infectious gangrene of the foot is a serious complication of diabetes that usually leads to a certain level of lower-extremity amputation (LEA). Nevertheless, the long-term survival and factors associated with mortality in such patients have yet to be elucidated. METHODS: A total of 157 patients with type 2 diabetes who received treatment for infectious foot gangrene at a major diabetic foot center in Taiwan from 2002 to 2009 were enrolled, of whom 90 had major LEAs (above the ankle) and 67 had minor LEAs (below the ankle). Clinical data during treatment were used for the analysis of survival and LEA, and survival was tracked after treatment until December 2012. RESULTS: Of the 157 patients, 109 died, with a median survival time of 3.12 years and 5-year survival rate of 40%. Age [hazard ratio 1.04 (95% confidence interval 1.01-1.06)], and major LEA [1.80 (1.05-3.09)] were independent factors associated with mortality. Patients with minor LEAs had a better median survival than those with major LEAs (5.5 and 1.9 years, respectively, P < 0.01). An abnormal ankle-brachial index was an independent risk factor [odds ratio 3.12 (95% CI 1.18-8.24)] for a poor outcome (major LEA) after adjusting for age, smoking status, hypertension, major adverse cardiac events, and renal function. CONCLUSIONS: Efforts to limit amputations below the ankle resulted in better survival of patients with infectious foot gangrene. An abnormal ankle-brachial index may guide physicians to make appropriate decisions with regards to the amputation level.
Asunto(s)
Amputación Quirúrgica , Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/cirugía , Gangrena/cirugía , Extremidad Inferior/cirugía , Factores de Edad , Anciano , Índice Tobillo Braquial , Diabetes Mellitus Tipo 2/fisiopatología , Pie Diabético/etiología , Pie Diabético/fisiopatología , Femenino , Gangrena/etiología , Gangrena/fisiopatología , Tasa de Filtración Glomerular/fisiología , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Infecciones de los Tejidos Blandos/etiología , Infecciones de los Tejidos Blandos/fisiopatología , Infecciones de los Tejidos Blandos/cirugíaRESUMEN
BACKGROUND: Dermal fillers have been increasingly used in minimally invasive facial esthetic procedures. This widespread use has led to a rise in reports of associated complications. The aim of this expert consensus report is to describe potential adverse events associated with dermal fillers and to provide guidance on their treatment and avoidance. METHODS: A multidisciplinary group of experts in esthetic treatments convened to discuss the management of the complications associated with dermal fillers use. A search was performed for English, French, and Spanish language articles in MEDLINE, the Cochrane Database, and Google Scholar using the search terms "complications" OR "soft filler complications" OR "injectable complications" AND "dermal fillers" AND "Therapy". An initial document was drafted by the Coordinating Committee, and it was reviewed and modified by the experts, until a final text was agreed upon and validated. RESULTS: The panel addressed consensus recommendations about the classification of filler complications according to the time of onset and about the clinical management of different complications including bruising, swelling, edema, infections, lumps and bumps, skin discoloration, and biofilm formation. Special attention was paid to vascular compromise and retinal artery occlusion. CONCLUSIONS: Clinicians should be fully aware of the signs and symptoms related to complications and be prepared to confidently treat them. Establishing action protocols for emergencies, with agents readily available in the office, would reduce the severity of adverse outcomes associated with injection of hyaluronic acid fillers in the cosmetic setting. This document seeks to lay down a set of recommendations and to identify key issues that may be useful for clinicians who are starting to use dermal fillers. Additionally, this document provides a better understanding about the diagnoses and management of complications if they do occur. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Asunto(s)
Técnicas Cosméticas/efectos adversos , Rellenos Dérmicos/efectos adversos , Ácido Hialurónico/efectos adversos , Guías de Práctica Clínica como Asunto , Infecciones de los Tejidos Blandos/etiología , Adulto , Anciano , Consenso , Rellenos Dérmicos/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Ácido Hialurónico/administración & dosificación , Incidencia , Inyecciones Subcutáneas , Masculino , Persona de Mediana Edad , Portugal , Medición de Riesgo , Infecciones de los Tejidos Blandos/epidemiología , Infecciones de los Tejidos Blandos/fisiopatología , EspañaAsunto(s)
Envejecimiento/fisiología , Colecistitis , Neumonía , Sepsis , Enfermedades Cutáneas Infecciosas , Infecciones de los Tejidos Blandos , Infecciones Urinarias , Anciano , Colecistitis/diagnóstico , Colecistitis/fisiopatología , Colecistitis/terapia , Humanos , Inmunosenescencia , Desnutrición , Afecciones Crónicas Múltiples , Manejo de Atención al Paciente/métodos , Neumonía/diagnóstico , Neumonía/fisiopatología , Neumonía/terapia , Ajuste de Riesgo , Factores de Riesgo , Sepsis/diagnóstico , Sepsis/etiología , Sepsis/mortalidad , Sepsis/terapia , Enfermedades Cutáneas Infecciosas/diagnóstico , Enfermedades Cutáneas Infecciosas/fisiopatología , Enfermedades Cutáneas Infecciosas/terapia , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones de los Tejidos Blandos/fisiopatología , Infecciones de los Tejidos Blandos/terapia , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/fisiopatología , Infecciones Urinarias/terapiaRESUMEN
A 41-year-old man with past medical history of kidney-liver transplantation requiring chronic immunosuppression presented 2 years posttransplant with a necrotizing soft tissue infection of his right thigh. Serial debridement to remove necrotic tissue was performed, and a Matrix HD Allograft Fenestrated (RTI Surgical, Alachua, FL) was applied. At 5-months post grafting, the patient demonstrated fully vascularized and intact skin. Under normal circumstances, a cadaveric allograft sloughs over several weeks and is not usually considered a permanent solution for wound closure. A systematic review of transplant patients on chronic immunosuppression with skin allografts demonstrates the potential for the indefinite survival of an allograft. Necrotizing soft tissue infections can definitively be treated using serial debridement and allograft transplantation in the chronically immunosuppressed.
Asunto(s)
Aloinjertos/inmunología , Supervivencia de Injerto , Huésped Inmunocomprometido/inmunología , Terapia de Inmunosupresión/métodos , Necrosis/cirugía , Trasplante de Piel , Infecciones de los Tejidos Blandos/cirugía , Trasplante Homólogo , Adulto , Cadáver , Desbridamiento/métodos , Supervivencia de Injerto/inmunología , Humanos , Trasplante de Riñón , Trasplante de Hígado , Masculino , Necrosis/inmunología , Necrosis/fisiopatología , Trasplante de Piel/métodos , Infecciones de los Tejidos Blandos/inmunología , Infecciones de los Tejidos Blandos/fisiopatología , Muslo/patología , Factores de Tiempo , Trasplante Homólogo/métodos , Resultado del TratamientoRESUMEN
Idiopathic pretracheal deep neck space infection is an extremely rare condition with potentially devastating complications. We present a series of 3 cases of pretracheal deep neck space infection that arose in the absence of trauma or a congenital lesion and that exhibited mediastinal spread. To the best of our knowledge, these cases represent the first reported series of this rare condition to be published in the English-language literature. All cultures grew Streptococcus milleri, and all patients had a favorable outcome. A high index of suspicion for a deep neck space infection is warranted in view of the devastating complications of this condition. Computed tomography is the investigation of choice. Treatment with intravenous antibiotics and surgical drainage, particularly when mediastinitis is present, is recommended. This rare presentation warrants a thorough investigation to identify the source of infection.
Asunto(s)
Antibacterianos/administración & dosificación , Mediastinitis , Disección del Cuello/métodos , Cuello , Infecciones de los Tejidos Blandos , Infecciones Estreptocócicas , Streptococcus milleri (Grupo)/aislamiento & purificación , Administración Intravenosa , Adulto , Antibacterianos/clasificación , Drenaje/métodos , Femenino , Humanos , Masculino , Mediastinitis/diagnóstico , Mediastinitis/etiología , Mediastinitis/terapia , Pruebas de Sensibilidad Microbiana/métodos , Persona de Mediana Edad , Cuello/diagnóstico por imagen , Cuello/cirugía , Infecciones de los Tejidos Blandos/complicaciones , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones de los Tejidos Blandos/fisiopatología , Infecciones de los Tejidos Blandos/terapia , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/fisiopatología , Infecciones Estreptocócicas/terapia , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
HYPOTHESIS AND BACKGROUND: The cause of isolated serratus palsy is multifactorial, but evaluation of the mechanism of the injury indicates that the lesion to the long thoracic nerve is mechanical in origin in most cases. What is unknown, however, is how etiology influences its long-term outcome. We believed that overuse injuries may recover sooner and better than acute traumatic, infectious, or inflammatory injuries. METHODS: We determined the presumed etiology of isolated serratus palsy in 92 patients treated by brace or observation only and compared it with its long-term outcome after a mean follow-up of 18.1 years (range, 2.1-26.9) by measuring pain, range of motion, and winging of the scapula. RESULTS: Trauma preceded 22 (24%) of the cases, exertion 37 (40%), infection 14 (15%), and surgery/anesthesia 10 (11%). In 9 (10%) cases, no etiologic factor was evident. Serratus palsy preceded by infection recovered better than did cases with no infection, and those with palsy preceded by surgery/anesthesia had a poorer outcome than did those with no surgery (axilla, chest, or any other areas) or anesthesia. Those palsies caused by acute trauma or acute or chronic overuse/exertion had the same recovery course. DISCUSSION AND CONCLUSION: Etiology of isolated serratus palsy influenced long-term outcome less than we had expected. It seems, however, that palsies caused by infection recover better and those caused by surgery wherever in the body recover most poorly.
Asunto(s)
Músculos Intermedios de la Espalda/fisiopatología , Parálisis/etiología , Parálisis/fisiopatología , Adolescente , Adulto , Trastornos de Traumas Acumulados/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/fisiopatología , Recuperación de la Función/fisiología , Estudios Retrospectivos , Escápula/fisiopatología , Infecciones de los Tejidos Blandos/fisiopatología , Adulto JovenRESUMEN
INTRODUCTION: The objectives of this study were to determine the prevalence of fever in adult ED patients with skin and soft tissue infections (SSTI) and to determine which, if any, physical exam, radiograph and laboratory test findings were associated with fever. METHODS: We conducted a prospective, observational study at an urban county trauma center of adults who presented to the ED for evaluation of suspected SSTI. ED providers measured area of erythema and induration using a tape measure, and completed data sheets indicating comorbid conditions and the presence or absence of physical exam findings. Fever was defined as any recorded temperature ≥ 38°C during the first six hours of ED evaluation. RESULTS: Of the 734 patients enrolled, 96 (13.1%) had fever. Physical and laboratory exam findings associated with the presence of a fever in multivariable logistic regression were the area of erythema, particularly the largest quartile of area of erythema, 144 - 5,000 cm2, (odd ratio [OR] = 2.9; 95% confidence interval [CI] [1.6 - 5.2]) and leukocytosis (OR = 4.4, 95% CI [2.7 - 7.0]). Bullae, necrosis, streaks, adenopathy, and bone involvement on imaging were not associated with fever. CONCLUSION: Fever is uncommon in patients presenting to the ED for evaluation of suspected SSTI. Area of erythema and leukocytosis were associated with fever and should be considered in future decision rules for the evaluation and treatment of SSTI.
Asunto(s)
Servicio de Urgencia en Hospital , Fiebre/diagnóstico , Hospitalización/estadística & datos numéricos , Enfermedades Cutáneas Infecciosas/diagnóstico , Infecciones de los Tejidos Blandos/diagnóstico , Adolescente , Adulto , Eritema , Femenino , Fiebre/fisiopatología , Fiebre/terapia , Humanos , Modelos Logísticos , Masculino , Examen Físico , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Enfermedades Cutáneas Infecciosas/fisiopatología , Enfermedades Cutáneas Infecciosas/terapia , Infecciones de los Tejidos Blandos/fisiopatología , Infecciones de los Tejidos Blandos/terapia , Estados UnidosAsunto(s)
Agammaglobulinemia , Antibacterianos/administración & dosificación , Dedos/patología , Enfermedades Genéticas Ligadas al Cromosoma X , Paroniquia , Proteínas Tirosina Quinasas/genética , Pseudomonas aeruginosa/aislamiento & purificación , Infecciones de los Tejidos Blandos , Adolescente , Agammaglobulinemia Tirosina Quinasa , Agammaglobulinemia/diagnóstico , Agammaglobulinemia/genética , Agammaglobulinemia/microbiología , Agammaglobulinemia/terapia , Diagnóstico Diferencial , Enfermedades Genéticas Ligadas al Cromosoma X/diagnóstico , Enfermedades Genéticas Ligadas al Cromosoma X/genética , Enfermedades Genéticas Ligadas al Cromosoma X/microbiología , Enfermedades Genéticas Ligadas al Cromosoma X/terapia , Humanos , Inmunización Pasiva , Masculino , Mutación , Neutropenia/diagnóstico , Paroniquia/tratamiento farmacológico , Paroniquia/microbiología , Paroniquia/fisiopatología , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Infecciones de los Tejidos Blandos/microbiología , Infecciones de los Tejidos Blandos/fisiopatologíaRESUMEN
Soft tissue infections with Scedosporium spp. are an uncommon but serious and emerging cause of infection in immunocompromised patients. Acute Medical Units (AMUs) in the UK are increasingly managing patients with cellulitis in an outpatient setting, therefore acute physicians should be aware of some of the more uncommon causes of soft tissue infection, particularly in patients not responding to initial antibiotic therapy. We present two cases of Scedosporium presenting to the AMU as cellulitis not responding to initial antibiotic therapy and outline the assessment and management of this important condition.