Necrotizing soft tissue infection - Revision history

Aidan at 17:10, 27 September 2024

2024-09-27T17:10:06Z

← Older revision		Revision as of 17:10, 27 September 2024
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	**If risk for MRSA, add [[vancomycin]] 15-20 mg/kg IV q8-12h		**If risk for MRSA, add [[vancomycin]] 15-20 mg/kg IV q8-12h
	**If water exposure, add two of: a [[Fluoroquinolones\|fluoroquinolone]], a [[Carbapenems\|carbapenem]], a third-generation [[Cephalosporins\|cephalosporin]], and/or [[doxycycline]] (should have double-coverage pending susceptibilities)		**If water exposure, add two of: a [[Fluoroquinolones\|fluoroquinolone]], a [[Carbapenems\|carbapenem]], a third-generation [[Cephalosporins\|cephalosporin]], and/or [[doxycycline]] (should have double-coverage pending susceptibilities)
	**Some recommend replacing [[clindamycin]] (and possibly [[vancomycin]]) with [[linezolid]]<ref>Nicolás Cortés-Penfield, Jonathan H Ryder, Should Linezolid Replace Clindamycin as the Adjunctive Antimicrobial of Choice in Group A Streptococcal Necrotizing Soft Tissue Infection and Toxic Shock Syndrome? A Focused Debate, ''Clinical Infectious Diseases'', 2022;, ciac720, https:~~//doi.org/~~10.1093/cid/ciac720~~</ref>~~		**Some recommend replacing [[clindamycin]] (and possibly [[vancomycin]]) with [[linezolid]][[CiteRef::10.1093/cid/ciac720]]
	*Then narrow based on the Gram stain an culture		*Then narrow based on the Gram stain an culture
	*Can consider IVIg, rarely, in [[streptococcal toxic shock syndrome\|streptococcal]] or [[staphylococcal toxic shock syndrome]]		*Can consider IVIg, rarely, in [[streptococcal toxic shock syndrome\|streptococcal]] or [[staphylococcal toxic shock syndrome]]

Aidan: added line about linezolid

2022-09-04T10:15:59Z

added line about linezolid

← Older revision		Revision as of 10:15, 4 September 2022
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	**[[Clindamycin]] 600 to 900 mg IV q8h, for synergy and the Eagle phenomenon and decreased toxin production		**[[Clindamycin]] 600 to 900 mg IV q8h, for synergy and the Eagle phenomenon and decreased toxin production
	**If risk for MRSA, add [[vancomycin]] 15-20 mg/kg IV q8-12h		**If risk for MRSA, add [[vancomycin]] 15-20 mg/kg IV q8-12h
	**If water exposure, add two of: a fluoroquinolone, a carbapenem, a third-generation cephalosporin, and/or [[doxycycline]] (should have double-coverage pending susceptibilities)		**If water exposure, add two of: a [[Fluoroquinolones\|fluoroquinolone]], a [[Carbapenems\|carbapenem]], a third-generation [[Cephalosporins\|cephalosporin]], and/or [[doxycycline]] (should have double-coverage pending susceptibilities)
			**Some recommend replacing [[clindamycin]] (and possibly [[vancomycin]]) with [[linezolid]]<ref>Nicolás Cortés-Penfield, Jonathan H Ryder, Should Linezolid Replace Clindamycin as the Adjunctive Antimicrobial of Choice in Group A Streptococcal Necrotizing Soft Tissue Infection and Toxic Shock Syndrome? A Focused Debate, ''Clinical Infectious Diseases'', 2022;, ciac720, https://doi.org/10.1093/cid/ciac720</ref>
	*Then narrow based on the Gram stain an culture		*Then narrow based on the Gram stain an culture
	*Can consider IVIg, rarely, in [[streptococcal toxic shock syndrome\|streptococcal]] or [[staphylococcal toxic shock syndrome]]		*Can consider IVIg, rarely, in [[streptococcal toxic shock syndrome\|streptococcal]] or [[staphylococcal toxic shock syndrome]]

Aidan: /* Management */

2022-08-16T17:14:36Z

Management

← Older revision		Revision as of 17:14, 16 August 2022
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	**If water exposure, add two of: a fluoroquinolone, a carbapenem, a third-generation cephalosporin, and/or [[doxycycline]] (should have double-coverage pending susceptibilities)		**If water exposure, add two of: a fluoroquinolone, a carbapenem, a third-generation cephalosporin, and/or [[doxycycline]] (should have double-coverage pending susceptibilities)
	*Then narrow based on the Gram stain an culture		*Then narrow based on the Gram stain an culture
	*Can consider IVIg, rarely, in [[toxic shock syndrome]]		*Can consider IVIg, rarely, in [[streptococcal toxic shock syndrome\|streptococcal]] or [[staphylococcal toxic shock syndrome]]

	===Eagle Effect===		===Eagle Effect===

Aidan: Aidan moved page Necrotizing soft tissue infections to Necrotizing soft tissue infection without leaving a redirect

2022-04-06T14:18:21Z

Aidan moved page Necrotizing soft tissue infections to Necrotizing soft tissue infection without leaving a redirect

← Older revision	Revision as of 14:18, 6 April 2022
(No difference)

Aidan: Text replacement - " species]]" to "]]"

2022-01-28T19:25:24Z

Text replacement - " species]]" to "]]"

← Older revision		Revision as of 19:25, 28 January 2022
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	*See Classification, below		*See Classification, below
	*Most commonly caused by monomicrobial [[Streptococcus pyogenes]], [[Staphylococcus aureus]], [[Clostridium ~~species~~]], or [[Vibrio ~~species~~]], or polymicrobial infections that include Gram-positives, Gram-negatives, and anaerobes		*Most commonly caused by monomicrobial [[Streptococcus pyogenes]], [[Staphylococcus aureus]], [[Clostridium]], or [[Vibrio]], or polymicrobial infections that include Gram-positives, Gram-negatives, and anaerobes

	===Classification===		===Classification===

Aidan: /* Management */

2021-03-08T13:40:46Z

Management

← Older revision		Revision as of 13:40, 8 March 2021
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	== Background ==		==Background==

	=== Microbiology ===		===Microbiology===

	* See Classification, below		*See Classification, below
	* Most commonly caused by monomicrobial [[Streptococcus pyogenes]], [[Staphylococcus aureus]], [[Clostridium species]], or [[Vibrio species]], or polymicrobial infections that include Gram-positives, Gram-negatives, and anaerobes		*Most commonly caused by monomicrobial [[Streptococcus pyogenes]], [[Staphylococcus aureus]], [[Clostridium species]], or [[Vibrio species]], or polymicrobial infections that include Gram-positives, Gram-negatives, and anaerobes

	===Classification===		===Classification===

	* Although it is classically divided into Type 1 (polymicrobial) and Type 2 (monomicrobial), others have proposed an extension to include Type 3 (water-associated monomicrobial) and Type 4 (fungal).		*Although it is classically divided into Type 1 (polymicrobial) and Type 2 (monomicrobial), others have proposed an extension to include Type 3 (water-associated monomicrobial) and Type 4 (fungal).
	* '''Type 1:''' polymicrobial, including [[Staphylococcus aureus]], [[Gram-negative bacilli]], and [[anaerobes]]		*'''Type 1:''' polymicrobial, including [[Staphylococcus aureus]], [[Gram-negative bacilli]], and [[anaerobes]]
	*'''Type 2:''' monomicrobial Gram-positive infections, primarily [[Streptococcus pyogenes]] (most common) but also [[Staphylococcus aureus]] or ''[[Clostridium]]'' (penetrating trauma, soil exposure)		*'''Type 2:''' monomicrobial Gram-positive infections, primarily [[Streptococcus pyogenes]] (most common) but also [[Staphylococcus aureus]] or ''[[Clostridium]]'' (penetrating trauma, soil exposure)
	*'''Type 3:''' monomicrobial Gram-negative infections, generally caused by water-associated ''[[Vibrio vulnificus]]'' or ''[[Aeromonas hydrophila]]''		*'''Type 3:''' monomicrobial Gram-negative infections, generally caused by water-associated ''[[Vibrio vulnificus]]'' or ''[[Aeromonas hydrophila]]''
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	*Surgical debridement!		*Surgical debridement!
	*Empiric antibiotics		*Empiric antibiotics
	**[[Piperacillin-tazobactam]]		**[[Piperacillin-tazobactam]] 4.5 g IV q8h (or, alternatively, [[meropenem]])
	**[[Clindamycin]], for synergy and the Eagle phenomenon and decreased toxin production		**[[Clindamycin]] 600 to 900 mg IV q8h, for synergy and the Eagle phenomenon and decreased toxin production
	**~~+/-~~ [[vancomycin]]		**If risk for MRSA, add [[vancomycin]] 15-20 mg/kg IV q8-12h
			**If water exposure, add two of: a fluoroquinolone, a carbapenem, a third-generation cephalosporin, and/or [[doxycycline]] (should have double-coverage pending susceptibilities)
	*Then narrow based on the Gram stain an culture		*Then narrow based on the Gram stain an culture
	*Can consider IVIg, rarely, in [[toxic shock syndrome]]		*Can consider IVIg, rarely, in [[toxic shock syndrome]]

Aidan: /* Classification */

2021-03-08T13:36:40Z

Classification

← Older revision		Revision as of 13:36, 8 March 2021
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	== ~~Classification~~ ==		== Background ==

			=== Microbiology ===
⚫	Although it is classically divided into Type 1 (polymicrobial) and Type 2 (monomicrobial), others have proposed an extension to include Type 3 (water-associated) and Type 4 (fungal).

			* See Classification, below
⚫	* '''Type 1:''' polymicrobial, including ''[[~~Staph.~~ aureus]]'', [[Gram-negative bacilli]], and [[anaerobes]]
			* Most commonly caused by monomicrobial [[Streptococcus pyogenes]], [[Staphylococcus aureus]], [[Clostridium species]], or [[Vibrio species]], or polymicrobial infections that include Gram-positives, Gram-negatives, and anaerobes
	* '''Type 2:''' monomicrobial [[Group A Streptococcus]] (''Strep. pyogenes'')
	** May include ''[[Staph. aureus]]'', ''[[Clostridium]]'' (penetrating trauma, soil exposure), ''[[Vibrio]]'' (water), ''[[Aeromonas]]'' (water)
⚫	* '''Type 3:''' monomicrobial Gram-negative infections, generally caused by water-associated ''[[Vibrio vulnificus]]'' or ''[[Aeromonas hydrophila]]''
⚫	* '''Type 4:''' fungal, caused by ''[[Candida]]'' species, and exceedingly rare

			===Classification===
⚫	== Management ==

		⚫	* Although it is classically divided into Type 1 (polymicrobial) and Type 2 (monomicrobial), others have proposed an extension to include Type 3 (water-associated monomicrobial) and Type 4 (fungal).
⚫	* Surgical debridement!
		⚫	* '''Type 1:''' polymicrobial, including [[Staphylococcus aureus]], [[Gram-negative bacilli]], and [[anaerobes]]
⚫	* Empiric antibiotics
			*'''Type 2:''' monomicrobial Gram-positive infections, primarily [[Streptococcus pyogenes]] (most common) but also [[Staphylococcus aureus]] or ''[[Clostridium]]'' (penetrating trauma, soil exposure)
⚫	** [[Piperacillin-tazobactam]]
		⚫	*'''Type 3:''' monomicrobial Gram-negative infections, generally caused by water-associated ''[[Vibrio vulnificus]]'' or ''[[Aeromonas hydrophila]]''
⚫	** [[Clindamycin]], for synergy and the Eagle phenomenon and decreased toxin production
		⚫	*'''Type 4:''' fungal, caused by ''[[Candida]]'' species, and exceedingly rare
⚫	** +/- [[vancomycin]]
⚫	* Then narrow based on the Gram stain an culture
⚫	* Can consider IVIg, rarely, in [[toxic shock syndrome]]

		⚫	==Management==
⚫	=== Eagle Effect ===

		⚫	*Surgical debridement!
⚫	* Originally, referred to decreased effectiveness of penicillins at high concentrations
		⚫	*Empiric antibiotics
⚫	* Now, refers to decreased effectiveness of penicillins at high bacterial burden (when in stationary phase)
		⚫	**[[Piperacillin-tazobactam]]
⚫	* [[Clindamycin]] kills enough of the bacteria that are in stationary phase that the bacteria return to logarithmic growth phase, where penicillins are more effective
		⚫	**[[Clindamycin]], for synergy and the Eagle phenomenon and decreased toxin production
		⚫	**+/- [[vancomycin]]
		⚫	*Then narrow based on the Gram stain an culture
		⚫	*Can consider IVIg, rarely, in [[toxic shock syndrome]]

		⚫	===Eagle Effect===
⚫	== Further Reading ==

		⚫	*Originally, referred to decreased effectiveness of penicillins at high concentrations
⚫	* RCT of IVIG: Madsen MB ''et al''. [https://doi.org/10.1007/s00134-017-4786-0 Immunoglobulin G for patients with necrotising soft tissue infection (INSTINCT): a randomised, blinded, placebo-controlled trial]. ''Intensive Care Med''. 2017;43:1585-93.
		⚫	*Now, refers to decreased effectiveness of penicillins at high bacterial burden (when in stationary phase)
		⚫	*[[Clindamycin]] kills enough of the bacteria that are in stationary phase that the bacteria return to logarithmic growth phase, where penicillins are more effective

		⚫	==Further Reading==

		⚫	*RCT of IVIG: Madsen MB ''et al''. [https://doi.org/10.1007/s00134-017-4786-0 Immunoglobulin G for patients with necrotising soft tissue infection (INSTINCT): a randomised, blinded, placebo-controlled trial]. ''Intensive Care Med''. 2017;43:1585-93.

	[[Category:Skin and soft tissue infections]]		[[Category:Skin and soft tissue infections]]

Aidan: /* Classification */

2020-06-17T02:17:36Z

Classification

← Older revision		Revision as of 02:17, 17 June 2020
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	* '''Type 2:''' monomicrobial [[Group A Streptococcus]] (''Strep. pyogenes'')		* '''Type 2:''' monomicrobial [[Group A Streptococcus]] (''Strep. pyogenes'')
	** May include ''[[Staph. aureus]]'', ''[[Clostridium]]'' (penetrating trauma, soil exposure), ''[[Vibrio]]'' (water), ''[[Aeromonas]]'' (water)		** May include ''[[Staph. aureus]]'', ''[[Clostridium]]'' (penetrating trauma, soil exposure), ''[[Vibrio]]'' (water), ''[[Aeromonas]]'' (water)
	* '''Type 3:''' monomicrobial Gram-negative infections, generally caused by water-associated ''[[Vibrio ~~vulnificans~~]]'' or ''[[Aeromonas hydrophila]]''		* '''Type 3:''' monomicrobial Gram-negative infections, generally caused by water-associated ''[[Vibrio vulnificus]]'' or ''[[Aeromonas hydrophila]]''
	* '''Type 4:''' fungal, caused by ''[[Candida]]'' species, and exceedingly rare		* '''Type 4:''' fungal, caused by ''[[Candida]]'' species, and exceedingly rare

Aidan: /* Classification */

2019-08-16T11:55:13Z

Classification

← Older revision		Revision as of 11:55, 16 August 2019
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	Although it is classically divided into Type 1 (polymicrobial) and Type 2 (monomicrobial), others have proposed an extension to include Type 3 (water-associated) and Type 4 (fungal).		Although it is classically divided into Type 1 (polymicrobial) and Type 2 (monomicrobial), others have proposed an extension to include Type 3 (water-associated) and Type 4 (fungal).

	* '''Type 1:''' polymicrobial, including ''[[Staph. aureus]]'', [[Gram-~~negatives~~ bacilli]], and [[anaerobes]]		* '''Type 1:''' polymicrobial, including ''[[Staph. aureus]]'', [[Gram-negative bacilli]], and [[anaerobes]]
	* '''Type 2:''' monomicrobial [[Group A Streptococcus]] (''Strep. pyogenes'')		* '''Type 2:''' monomicrobial [[Group A Streptococcus]] (''Strep. pyogenes'')
	** May include ''[[Staph. aureus]]'', ''[[Clostridium]]'' (penetrating trauma, soil exposure), ''[[Vibrio]]'' (water), ''[[Aeromonas]]'' (water)		** May include ''[[Staph. aureus]]'', ''[[Clostridium]]'' (penetrating trauma, soil exposure), ''[[Vibrio]]'' (water), ''[[Aeromonas]]'' (water)

Aidan: /* Classification */

2019-08-16T11:55:01Z

Classification

← Older revision		Revision as of 11:55, 16 August 2019
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	Although it is classically divided into Type 1 (polymicrobial) and Type 2 (monomicrobial), others have proposed an extension to include Type 3 (water-associated) and Type 4 (fungal).		Although it is classically divided into Type 1 (polymicrobial) and Type 2 (monomicrobial), others have proposed an extension to include Type 3 (water-associated) and Type 4 (fungal).

	* '''Type 1:''' polymicrobial, including ''~~Staphaureus~~'', Gram-negatives, and anaerobes		* '''Type 1:''' polymicrobial, including ''[[Staph. aureus]]'', [[Gram-negatives bacilli]], and [[anaerobes]]
	* '''Type 2:''' monomicrobial Group A Streptococcus (''Strep. pyogenes'')		* '''Type 2:''' monomicrobial [[Group A Streptococcus]] (''Strep. pyogenes'')
	** May include ''~~Staphylococcus~~ aureus'', ''Clostridium'' (penetrating trauma, soil exposure), ''Vibrio'' (water), ''Aeromonas'' (water)		** May include ''[[Staph. aureus]]'', ''[[Clostridium]]'' (penetrating trauma, soil exposure), ''[[Vibrio]]'' (water), ''[[Aeromonas]]'' (water)
	* '''Type 3:''' monomicrobial Gram-negative infections, generally caused by water-associated ''Vibrio vulnificans'' or ''Aeromonas hydrophila''		* '''Type 3:''' monomicrobial Gram-negative infections, generally caused by water-associated ''[[Vibrio vulnificans]]'' or ''[[Aeromonas hydrophila]]''
	* '''Type 4:''' fungal, caused by ''Candida'' species, and exceedingly rare		* '''Type 4:''' fungal, caused by ''[[Candida]]'' species, and exceedingly rare

	== Management ==		== Management ==