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Review

Antibiotics in Necrotizing Soft Tissue Infections

1
Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 75571 Paris, France
2
Sorbonne Université, Université Pierre-et-Marie Curie, 75001 Paris, France
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Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France
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Groupe de Recherche Clinique CARMAS, Faculté de Médecine, Université Paris Est Créteil, 94010 Créteil, France
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Service de Pharmacie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France
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Unité Transversale de Traitement des Infections, Département de Prévention, Diagnostic et Traitement des Infections, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France
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Département de Prévention, Diagnostic et Traitement des Infections, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France
8
Research Group Dynamic, Faculté de Santé de Créteil, Université Paris-Est Créteil Val de Marne (UPEC), 94010 Créteil, France
9
Service de Dermatologie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France
*
Author to whom correspondence should be addressed.
Academic Editor: David P. Nicolau
Antibiotics 2021, 10(9), 1104; https://doi.org/10.3390/antibiotics10091104
Received: 27 August 2021 / Revised: 8 September 2021 / Accepted: 10 September 2021 / Published: 13 September 2021
(This article belongs to the Special Issue Antibiotic Usage in Acute Situations)
Necrotizing soft tissue infections (NSTIs) are rare life-threatening bacterial infections characterized by an extensive necrosis of skin and subcutaneous tissues. Initial urgent management of NSTIs relies on broad-spectrum antibiotic therapy, rapid surgical debridement of all infected tissues and, when present, treatment of associated organ failures in the intensive care unit. Antibiotic therapy for NSTI patients faces several challenges and should (1) carry broad-spectrum activity against gram-positive and gram-negative pathogens because of frequent polymicrobial infections, considering extended coverage for multidrug resistance in selected cases. In practice, a broad-spectrum beta-lactam antibiotic (e.g., piperacillin-tazobactam) is the mainstay of empirical therapy; (2) decrease toxin production, typically using a clindamycin combination, mainly in proven or suspected group A streptococcus infections; and (3) achieve the best possible tissue diffusion with regards to impaired regional perfusion, tissue necrosis, and pharmacokinetic and pharmacodynamic alterations. The best duration of antibiotic treatment has not been well established and is generally comprised between 7 and 15 days. This article reviews the currently available knowledge regarding antibiotic use in NSTIs. View Full-Text
Keywords: necrotizing soft tissue infections; antibiotic; pharmacokinetics; pharmacodynamics; tissue diffusion; anti-toxinic; piperacillin-tazobactam; clindamycin; beta-lactam necrotizing soft tissue infections; antibiotic; pharmacokinetics; pharmacodynamics; tissue diffusion; anti-toxinic; piperacillin-tazobactam; clindamycin; beta-lactam
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MDPI and ACS Style

Urbina, T.; Razazi, K.; Ourghanlian, C.; Woerther, P.-L.; Chosidow, O.; Lepeule, R.; de Prost, N. Antibiotics in Necrotizing Soft Tissue Infections. Antibiotics 2021, 10, 1104. https://doi.org/10.3390/antibiotics10091104

AMA Style

Urbina T, Razazi K, Ourghanlian C, Woerther P-L, Chosidow O, Lepeule R, de Prost N. Antibiotics in Necrotizing Soft Tissue Infections. Antibiotics. 2021; 10(9):1104. https://doi.org/10.3390/antibiotics10091104

Chicago/Turabian Style

Urbina, Tomas, Keyvan Razazi, Clément Ourghanlian, Paul-Louis Woerther, Olivier Chosidow, Raphaël Lepeule, and Nicolas de Prost. 2021. "Antibiotics in Necrotizing Soft Tissue Infections" Antibiotics 10, no. 9: 1104. https://doi.org/10.3390/antibiotics10091104

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