CURRENT Essentials of Critical Care.pdf

146 Current Essentials of Critical Care■■■Necrotizing Soft Tissue InfectionEssentials of Diagnosis• Rapidly spreading infection with widespread tissue necrosiswith potentially high mortality rate• Clinical features disproportionate to physical findings; edemaand tenderness beyond area of erythema, palpable crepitus, vesiclesor bullae• Fever, tachycardia, hypotension common• Leukocytosis, disseminated intravascular coagulation, elevatedcreatinine kinase, acidosis, renal failure• Three types: Group A streptococcal infection; clostridial infection(gas gangrene, myonecrosis); polymicrobial infection (eg,Fournier disease)• Patients with impaired host defense at higher riskDifferential Diagnosis• Cellulitis• Myositis• Thrombophlebitis• Compartment syndrome• Soft tissue abscessTreatment• Early diagnosis and aggressive treatment critical for survival• Emergent surgical exploration indicated for any suspicion ofnecrotizing soft tissue infection• Immediate surgical exploration and debridement; surgical reexplorationevery 1–2 days to ensure that wound edges are free ofnecrosis• Broad-spectrum antibiotics to cover aerobic and anaerobic organisms■ PearlFindings suggestive of invasive soft tissue involvement, such as crepitusor blistering, are present in 40% of patients.ReferenceNichols RL: Clinical presentations of soft-tissue infections and surgical site infections.Clin Infect Dis 2001;33(Suppl 2):S84. [PMID: 11486304]