Sánchez Porto A, Martín Gómez M, León Gil C, Martín Mazuelos E, Marín Morales J, Royo Balbontín A
Servicio de Microbiología Clínica, Hospital Universitario de Valme, Sevilla.
Enferm Infecc Microbiol Clin. 1991 Jan;9(1):22-5.
The diagnosis of necrotizing soft tissue infection (NSTI) is based on a high suspicion index and/or clinical experience. Mortality is associated with delayed diagnosis and use of early surgical treatment, and also with the underlying disease and the patient's age. Usually they are mixed infections; therefore, in addition to surgical therapy an adequate antibiotic coverage is required. The latter, in cases of severe renal failure, might consist in monotherapy. All these guidelines can be modified on the basis of bacteriological findings. The Gram stain of a surgical sample can be very useful to select an appropriate empirical therapy. From a clinical point of view, we suggest to pay extreme attention to the findings consistent with NSTI: tenderness and/or crackling of soft tissue, rapid expansion through natural planes, or visualization of gas in the x-ray film of the involved zone, particularly if associated with a rapid deterioration of the general condition of the patient.
坏死性软组织感染（NSTI）的诊断基于高度的怀疑指数和/或临床经验。死亡率与诊断延迟、早期手术治疗的使用有关，也与基础疾病和患者年龄有关。通常它们是混合感染；因此，除了手术治疗外，还需要充分的抗生素覆盖。在严重肾衰竭的情况下，后者可能采用单一疗法。所有这些指南可根据细菌学检查结果进行调整。手术样本的革兰氏染色对于选择合适的经验性治疗非常有用。从临床角度来看，我们建议要格外关注与NSTI相符的表现：软组织压痛和/或捻发音、通过自然间隙迅速扩展、或在受累区域的X线片上显示气体，特别是如果伴有患者一般状况的迅速恶化。
