Search Results (74)

Background: Necrotizing soft tissue infections (NSTIs) remain a significant source of in-hospital morbidity and mortality in the U.S. and around the world, yet the need for a reliable tool to assess prognosis early in treatment remains unaddressed in the current medical literature. Many scoring systems have been developed; however, none have proven to be entirely reliable for use in patients with NSTIs. Methods: Using collected data through a PubMed and Google Scholar search, this review provides an overview of five scoring systems—LRINEC, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), NECROSIS, and POTTER—while highlighting potential areas for further improvement of these scoring systems or the conception of a novel, more effective system. Results: The most widely used scoring tool, the Laboratory Risk Indicator for Necrotizing Fasciitis Score (LRINEC), lacks high sensitivity and requires supplementation of other clinical parameters. The NECROSIS score offers a potentially improved system, though it lacks necessary external validation. NLR and PLR provide reliable measurements for immune response; however, they lack specificity for NSTI and require further research to determine parameters like cutoff values. The POTTER score, though not valid for use in patients with NSTI, poses a novel system utilizing AI technology and machine learning. Conclusions: This review concludes that further development of a reliable scoring system that accounts for the many factors involved in NSTI is required and may benefit from an integrative model like the POTTER score. Full article

Background and Objectives: Traditionally, full-thickness skin defects (FTSDs) are covered with split-thickness skin grafts (STSGs). This usually provides an epidermal coverage but entails a high risk of hypertrophic scarring mainly due to the absence of the dermal layer. The Novosorb^® Biodegradable Temporising Matrix (BTM) is a novel synthetic dermal substitute that has been used for the reconstruction of various complex and/or large defects in our center. The aim of this article is to evaluate the clinical performance of the BTM as a synthetic dermal substitute for complex FTSD reconstruction in a European context. Materials and methods: This case series focused on the treatment of complex FTSDs with the BTM. After wound debridement, the BTM was applied according to a defined protocol. Once adequate vascularization was observed, the sealing membrane was removed and the neo-dermis was covered with STSGs. Patient demographics, comorbidities, wound defect localization and etiology, wound bed preparations, time of BTM application and removal, time to complete wound healing after STSG, complications, and HTS formation were recorded. Results: The BTM was used to treat FTSDs in six patients with complex wounds from degloving (3), burns (1), ulcerations (1), and necrotizing fasciitis (1). Successful integration occurred in five cases (83%), with one partial integration. The BTM remained in situ for an average of 20.7 days before delamination and STSG coverage. No major complications occurred, though one case had hypergranulation with secondary STSG infection. Two patients were lost to follow-up, while the remaining four had excellent aesthetic and functional outcomes with good-quality scars. Conclusions: Within the limits of this small and heterogeneous case series, the BTM appears to be a promising option for the reconstruction of complex FTSDs of varying etiologies. Its successful integration in most cases and limited complication rate support its clinical potential. However, given this study’s retrospective design and limited sample size, further prospective studies are required to validate these findings and assess long-term outcomes. Full article

Background: Periocular necrotizing fasciitis (PNF) is a rare but life-threatening emergency that requires immediate recognition, as delayed diagnosis can worsen patient outcomes. To address this critical issue, we conducted the largest and most comprehensive systematic review to date, providing valuable insights into the diagnosis and treatment of PNF to improve clinical practice and patient prognosis. Methods: A search on Pubmed, Scopus, Embase, and WOS from January 2013 to August 2024 was performed. Only the cases of NF affecting the periocular region were included with no age limitations. Article selection and data extraction were performed independently by two investigators to avoid bias. Bias on individual studies is low as they represent case reports or case series, and publication bias is partially addressed including all the large case series even if no individual data could be retrieved. Results: The cohort included a total of 183 patients with PNF, with detailed patient-specific data for 107 individuals and only aggregated data for another 76. The average age at diagnosis was 54.2 years, and females constituted 44% of the population sample. Notably, 49.6% of the patients were immunocompromised. Streptococcus pyogenes was the predominant causative organism, identified in 79.8% of the cases. Most infections were unilateral (72.1%) without extension beyond the periocular area (54.7%). Most patients (89.6%) underwent surgical debridement alongside intravenous antibiotics. Septic shock occurred in 26.8% of the patients, and the overall mortality rate was 4.9%. Visual acuity was unaffected in 67.5% of the patients, though 18.2% progressed to blindness on the affected side. Reconstructive efforts predominantly involved skin grafting, both free and local pedunculate flaps as well as secondary healing in some instances. Conclusions: This systematic review summarizes the understanding of periocular necrotizing fasciitis’ (PNF) demographic trends, clinical manifestations, causative pathogens, and patient outcomes. Vigilance for PNF should be heightened when the clinical assessment of the patient’s eyelids reveals rapidly spreading edema and induration, subcutaneous emphysema, or necrotic bullae and/or eschar. Prompt identification and expedited intervention, including debridement and targeted antibiotic therapy, critically influence prognosis. Despite optimal management, patients may still suffer from significant aesthetic impairment, severe complications such as vision loss, or death due to septic shock. Full article

Background: Necrotizing soft tissue infections (NSTIs) of the lower extremities represent a surgical emergency with high morbidity, complex reconstruction, and considerable healthcare demands. Free tissue transfer (FTT) is increasingly utilized for limb salvage in extensive soft tissue defects, yet its implications for hospital resource utilization remain unclear. This study aims to compare clinical outcomes and perioperative resource demands between FTT and local flap (LF) reconstruction in NSTI patients. Methods: A retrospective case series was conducted at a tertiary referral center between September 2022 and January 2025, including eight patients with NSTI of the lower extremity (FTT, n = 4; LF, n = 4). Demographic data, comorbidities, surgical timing, complication profiles, and resource utilization metrics—including operative duration, hospitalization length, and number of procedures—were analyzed. All FTT cases underwent preoperative CT angiography as part of institutional protocol. Results: Mean time to definitive reconstruction was longer in the FTT group (17.25 vs. 8 days, p = 0.15), reflecting staged infection control. FTT procedures demonstrated significantly longer operative times (331.75 vs. 170.25 minutes, p = 0.015), but there was no significant difference in total hospital stay (34.75 vs. 27.71 days, p = 0.65). No cases of flap loss or venous congestion were observed, and outcomes were optimized via delayed dangling protocols. Conclusions: FTT is a viable and effective reconstructive modality for lower extremity NSTIs. Despite increased surgical complexity, FTT did not significantly increase hospital resource utilization, supporting its role in limb preservation among appropriately selected patients. Full article

Background and Clinical Significance: Necrotizing fasciitis (NF) is a rare skin and soft tissue infection that progresses rapidly to necrosis and can be life-threatening. The incidence varies by geographic region but is generally low, with a mortality rate ranging between 11 and 22%. Early diagnosis and treatment are crucial for survival, particularly in patients with underlying conditions such as immune suppression, diabetes, obesity, trauma, recent surgical procedures, or renal pathology. However, the relationship between pregnancy and NF has not been extensively studied. Case Presentation: The case presented involves a 37-year-old, 20-week pregnant woman, who presented to the emergency department with septic shock and left forearm compartment syndrome. She reported no recent trauma or obvious source of contamination. The patient was immediately admitted and taken to the operating room. During admission, she underwent three surgeries, consisting of staged debridement, fasciectomy, and vacuum therapy and skin grafting. The patient was carefully monitored in the intensive care unit and multiple obstetrical consultations were performed to monitor the fetus. The patient was discharged with a fully integrated graft and with the donor area undergoing epithelialization. Conclusions: This case highlights the importance of early diagnosis and treatment of NF, particularly in high-risk patients, and the need for further research into the relationship between pregnancy and NF. Full article

Since the beginning of December 2022, an unusually high number of cases and deaths of Group A Streptococcus (GAS) infections has been reported in many European countries. GAS infection frequently causes mild diseases such as pharyngitis, tonsillitis, impetigo, cellulitis, and scarlet fever. However, in rare instances, GAS infection can lead to invasive, life-threatening conditions like necrotizing fasciitis and toxic shock syndrome, which are associated with high mortality. The aim of the study was to present the clinical course of invasive Streptococcus pyogenes infections and to highlight the increase in the incidence of severe infections of this etiology, similar to trends observed in other European countries. The study included 11 patients with severe, invasive infections caused by S. pyogenes accompanied by sepsis or septic shock, treated at the 4th Clinical Military Hospital in Wroclaw between December 2022 and May 2023. Among 11 patients, 6 had streptococcal skin and soft tissue infections, 3 had pneumonia caused by S. pyogenes, 1 had streptococcal otitis, and 1 had a knee joint infection. Nine developed septic shock, and three died from fulminant streptococcal toxic shock syndrome (STSS). Physicians should be aware of the increased prevalence of invasive GAS (iGAS) infections; timely diagnosis and effective treatment are crucial to reducing the risk of severe complications, including death. Full article

Vibrio vulnificus (V. vulnificus) is a Gram-negative, halophilic bacillus known for causing severe infections such as gastroenteritis, necrotizing fasciitis, and septic shock, with mortality rates exceeding 50% in high-risk individuals. Transmission occurs primarily through the consumption of contaminated seafood, exposure of open wounds to infected water, or, in rare cases, insect bites. The bacterium thrives in warm, brackish waters with high salinity levels, and its prevalence is rising due to the effects of climate change, including warming ocean temperatures and expanding coastal habitats. High-risk populations include individuals with underlying conditions such as chronic liver disease, diabetes, or immunosuppression, which heighten susceptibility to severe outcomes. The pathogenicity of V. vulnificus is mediated by an array of virulence factors, including hemolysins, proteases, and capsular polysaccharides, as well as mechanisms facilitating iron acquisition and immune system evasion. Clinical manifestations range from localized gastrointestinal symptoms to life-threatening systemic infections such as septicemia. Rare but severe complications, including pneumonia and meningitis, have also been reported. Treatment typically involves the use of doxycycline in combination with third-generation cephalosporins, although the emergence of multidrug-resistant strains is an escalating concern. Alternative therapeutic approaches under investigation include natural compounds such as resveratrol and the application of antimicrobial blue light. For necrotizing infections, prompt and aggressive surgical intervention remains essential to improving patient outcomes. As global temperatures continue to rise, understanding the epidemiology of V. vulnificus and developing innovative therapeutic strategies are critical to mitigating its growing public health impact. Full article

Diabetes is a complex global healthcare burden involving multiple organ systems with its prevalence on the rise. SGLT2 inhibitors enhance glucose excretion. The objective of our literature review was to determine the association between cutaneous adverse drug reactions (CADRs) and the use of SGLT2 inhibitors. We collected data on CADRs related to the use of SGLT2 inhibitors from all available published articles and studied their details to understand the patterns of their association. PubMed, Cochrane, Google, and Embase were searched for relevant articles. A total of 37 papers were included and studied. Most articles were case reports followed by pharmacovigilance studies, case series, and reviews. The cutaneous findings ranged from benign eruptions to severe reactions. The available literature suggests a strong link between the use of SGLT2 inhibitors and Fournier’s gangrene/necrotizing fasciitis. T2DM patients using SGLT2 inhibitors have also developed fixed drug eruptions, drug-induced pruritus, and Sweet syndrome/acute febrile neutrophilic dermatosis, among other skin lesions. We found that SGLT2 inhibitors present a risk of developing CADRs. Raising awareness among healthcare providers regarding CADRs to SGLT2 inhibitors can reduce complications, minimize hospitalizations, and improve patient care in the vulnerable population of diabetes patients. Full article

Background: Monomicrobial Enterobacterales necrotizing fasciitis is associated with exceedingly high mortality rates. Although effective antimicrobial therapy is an important part of treatment, the traditional microbiological diagnostic methods are not fast enough to meaningfully influence early therapeutic decisions. Methods: Here, we report the application of the BioMérieux Biofire Filmarray Joint Infection Panel (BFJIP) for the rapid detection of the causative agent and susceptibility prediction in such a case. Aside from the BFJIP-based rapid diagnostic approach and culturing, the whole genome sequencing (WGS) of the causative agent was performed using Illumina MiSeq and Oxford Nanopore MinION platforms. Results: The BFJIP indicated the presence of K. pneumoniae, without KPC, VIM, IMP, NDM, OXA-48 carbapenemase genes, and CTX-M-type extended-spectrum beta-lactamases. Based on the WGS data, the isolate belonged to the K1-capsule-type ST23, harboured a pNTUH-2044-like plasmid, and was positive for all the virulence factors associated with this lineage. The conventional susceptibility results were also in accordance with the BFJIP results; the isolate lacked any of these acquired resistance mechanisms. Conclusions: Despite this being the first case of the successful identification of pathogenic bacteria in necrotising fasciitis using this assay, the BFJIP may become a useful tool for rapid identification of pathogens in necrotising fasciitis cases and guiding antimicrobial therapy for better clinical outcomes. Full article

Objectives: Fournier’s gangrene is an aggressive, rapidly progressing, and life-threatening necrotizing fasciitis of the perineal and genital regions. Various scoring systems have been developed for predicting survival and prognosis in Fournier’s gangrene. This retrospective study aimed to evaluate the effectiveness of the newly developed Fournier’s gangrene mortality index (FGMI) in predicting mortality associated with Fournier’s gangrene. Methods: The study included patients over the age of 18 years who were followed-up with a diagnosis of Fournier’s gangrene in the general surgery clinics of three different hospitals in Şanlıurfa province between 2014 and 2024. The patients included in this study were divided into two groups: deceased (n = 20) and surviving (n = 149). In FGMI, the parameters used were age, creatinine level, albumin level, lymphocyte percentage, and neutrophil-to-lymphocyte ratio. Based on the total score and risk assessment, <5 points were categorized as low-to-moderate mortality risk and ≥5 points as high mortality risk. Results: A total of 169 patients with a diagnosis of Fournier’s gangrene were included in the study; 87 were men (51.48%). The median age of all patients was 53 (40–63) years; 20 patients (11.8%) died. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score did not show a statistically significant difference between the deceased and surviving groups (p = 0.5). Compared to the survivors, the deceased had higher neutrophil counts, neutrophil percentages, neutrophil-to-lymphocyte ratios, platelet-to-lymphocyte ratios, and C-reactive protein-to-albumin ratios, whereas lymphocyte counts, lymphocyte percentages, eosinophil counts, eosinophil percentages, monocyte counts, and monocyte percentages were lower, and these differences were statistically significant. According to receiver operating characteristic (ROC) analysis, the ROC-area under the curve for predicting mortality based on an FGMI score of ≥5 was 0.88 (95% CI: 0.80–0.95) with a sensitivity of 90% and a specificity of 70% (p < 0.001). Univariate risk analysis was performed, and the odds ratio revealed that mortality risk in patients followed-up for Fournier’s gangrene with a FGMI score of ≥5 was 20 times higher (4.48–90.91) (p < 0.001). Conclusions: The results reveal that the FGMI score is a scoring system that can predict mortality at the initial clinical presentation of patients with Fournier’s gangrene. Another important finding of the present study is that the LRINEC score was not sufficiently effective in predicting mortality. Full article

Necrotizing fasciitis, which is categorized as a medical and surgical emergency, is a life-threatening soft tissue infection. Necrotizing fasciitis diagnosis primarily relies on computed tomography (CT), magnetic resonance imaging (MRI), ultrasound scans, surgical biopsy, blood tests, and expert knowledge from doctors or nurses. Necrotizing fasciitis develops rapidly, making early diagnosis crucial. With the rapid progress of information technology and systems, in terms of both hardware and software, deep learning techniques have been employed to address problems in various fields. This study develops an information system using convolutional neural networks (CNNs), Optuna, and digital images (CNNOPTDI) to detect necrotizing fasciitis. The determination of the hyperparameters in convolutional neural networks plays a critical role in influencing classification performance. Therefore, Optuna, an optimization framework for hyperparameter selection, is utilized to optimize the hyperparameters of the CNN models. We collect the images for this study from open data sources such as Open-i and Wikipedia. The numerical results reveal that the developed CNNOPTDI system is feasible and effective in identifying necrotizing fasciitis with very satisfactory classification accuracy. Therefore, a potential future application of the CNNOPTDI system could be in remote medical stations or telemedicine settings to assist with the early detection of necrotizing fasciitis. Full article

(1) Background: Necrotizing fasciitis is known as a severe condition with a high risk of mortality, placing it among the most feared infections. In most cases, it has a polymicrobial etiology (type 1), requiring complex treatment that is continuously adapted to the evolving microbiological status. The facial localization of the disease is rare, fulminant progressing, and is often life-threatening. (2) Methods: We present the case of a patient with multiple comorbidities who, following trauma to the nasal dorsum, developed a wound with a rapid and severe progression to extensive bilateral periorbital necrosis. This was accompanied by a dramatic deterioration in their general condition, a polymicrobial biological status, and fluctuating progression despite instituted treatment (both medical and surgical). (3) Results: The patient required multiple surgical interventions by multidisciplinary teams (plastic surgery; ear, nose, and throat specialist (ENT); maxillofacial surgery; and ophthalmology), experiencing periods of a severe, life-threatening general condition, necessitating prolonged orotracheal intubation. Wounds with fluctuating progression, extensive skin necrosis, and significant post-excisional soft tissue defects required skin graft coverage. The result meant a saved life and functional and aesthetic sequelae at the level of the face. (4) Conclusions: Necrotizing fasciitis of the face is a rare and severe disease that must be recognized early and treated appropriately by a multidisciplinary team to save the patient’s life and minimize the resulting functional and aesthetic sequelae. Full article

Streptococcus pyogenes, or Group A Streptococcus (GAS), is responsible for over 500,000 deaths per year. Approximately 15% of these deaths are caused by necrotizing soft-tissue infections. In 2008, we isolated an M5 GAS, named the LO1 strain, responsible for the nosocomial transmission of necrotizing fasciitis between a baby and a nurse in Belgium. To understand this unusual transmission route, the LO1 strain was sequenced. A comparison of the LO1 genome and transcriptome with the reference M5 Manfredo strain was conducted. We found that the major differences were the presence of an additional DNase and a Tn916-like transposon in the LO1 and other invasive M5 genomes. RNA-seq analysis showed that genes present on the transposon were barely expressed. In contrast, the DNases presented different expression profiles depending on the tested conditions. We generated knock-out mutants in the LO1 background and characterized their virulence phenotype. We also determined their nuclease activity on different substrates. We found that DNases are dispensable for biofilm formation and adhesion to both keratinocytes and pharyngeal cells. Three of these were found to be essential for blood survival; Spd4 and Sdn are implicated in phagocytosis resistance, and Spd1 is responsible for neutrophil extracellular trap (NET) degradation. Full article

Objectives: The aim of the current report is to present three cases of necrotizing fasciitis and sepsis caused by Vibrio vulnificus on the Bulgarian Black Sea coast. Materials and Methods: Two of the patients are males, 70 and 86 years of age, respectively, and one is an 86-year-old female. Data were collected from the patients’ examination records. V. vulnificus was isolated on 5% sheep blood agar from wound and blood samples and identified by the automated system Phoenix M50 (BD, Franklin Lakes, NJ, USA). Antimicrobial susceptibility was tested with two well-known methods (disk diffusion and broth microdilution). Results: All of the patients were admitted to our hospital due to pain, swelling, ulceration, and bullae on the legs and were febrile. They underwent surgery and received intensive care support. One of the patients developed septicemia and septic shock; one of his legs was amputated, but the outcome was fatal. The other patient received immediate approptiate antibiotic and surgical treatment, and the outcome was favorable. The third patient underwent emergency fasciotomy but died a few hours after admission. Conclusions: Global climate change is affecting the distribution of Vibrio spp., and their incidence is expected to increase. It is important to highlight the need for awareness among immunocompromised and elderly patients of the potential threat posed by V. vulnificus infections. Full article

Necrotizing fasciitis (NF) is a severe and life-threatening soft tissue infection that requires timely and accurate diagnosis to improve patient outcomes. The early diagnosis of NF remains challenging due to its similarity to other subcutaneous soft tissue infections like cellulitis. This study aims to employ machine learning techniques to differentiate NF from cellulitis and enhance the diagnostic accuracy of NF by developing a modified LRINEC (MLRINEC) score. These modifications aimed to improve the sensitivity and specificity of NF diagnosis. The study utilized three machine learning classifiers—Logistic Regression, decision tree, and Random Forest—to assess their effectiveness in distinguishing between NF and cellulitis cases. The MLRINEC score was developed by incorporating six key blood test parameters: creatinine, hemoglobin, platelet count, sodium, white blood cell count, and C-reactive protein using laboratory data from Maha Sarakham Hospital in Northeastern Thailand. Our findings indicate that the decision tree classifier demonstrated superior performance, achieving the highest recall, particularly in accurately identifying NF cases. A feature importance analysis revealed that hemoglobin levels and white blood cell counts were the most critical factors influencing the model’s predictions. The platelet count (PT), C-reactive protein (CRP), and creatinine (CT) also played important roles, while sodium levels (NA) were the least influential. The MLRINEC score demonstrates high accuracy in classifying NF and cellulitis patients, paving the way for improved diagnostic protocols in clinical settings. Full article