Leiblein M, Marzi I, Sander A L, Barker J H, Ebert F, Frank J
Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
Experimental Trauma and Orthopedic Surgery, Frankfurt Initiative for Regenerative Medicine, Goethe-Universität, Friedrichsheim gGmbH, 60528, Frankfurt/Main, Germany.
Eur J Trauma Emerg Surg. 2018 Apr;44(2):279-290. doi: 10.1007/s00068-017-0792-8. Epub 2017 May 8.
Necrotizing fasciitis is a life-threatening soft tissue infection characterized by a rapid spreading infection of the subcutaneous tissue and in particular the fascia. The management of infected tissues requires a rapid diagnosis, immediate aggressive surgical management and an extended debridement. In some cases early amputations of the affected tissues and maximum intensive care treatment, in case of sepsis, are required. Due to a rising number of cases we aimed to evaluate our patients in a retrospective review.
All patients diagnosed with necrotizing fasciitis from 2014 to 2016 (21 months) in our level one trauma center were identified. Their charts were reviewed and data were analyzed in terms of demographic and social information, microbiological results, therapeutic course, socio-economic outcome and mortality.
We found 15 patients with necrotizing fasciitis. None of these died in the observation period. The mean number of surgical interventions was seven. Two patients underwent limb amputation; diabetes mellitus was assigned with a significant higher risk for amputation. The mean hospitalization was 32 days, including 8 days on intensive care unit. Of the discovered bacteria 93% were sensitive to the initial antibiotic treatment with Ampicillin, Clindamycin and Clont.
Surgical therapy is indicated if necrotizing fasciitis is suspected. Diabetes mellitus was a clinical predictor of limb amputation in patients with necrotizing fasciitis in our cohort. Aminopenicillin ± sulbactam in combination with clindamycin and/or metronidazole is recommended as initial calculated antibiotic treatment.
坏死性筋膜炎是一种危及生命的软组织感染，其特征是皮下组织尤其是筋膜的感染迅速扩散。感染组织的处理需要快速诊断、立即积极的手术处理和广泛的清创术。在某些情况下，对于受影响的组织需要早期截肢，对于败血症患者则需要进行最大程度的重症监护治疗。由于病例数不断增加，我们旨在通过回顾性研究对我们的患者进行评估。
确定了2014年至2016年（21个月）在我们的一级创伤中心诊断为坏死性筋膜炎的所有患者。查阅他们的病历，并就人口统计学和社会信息、微生物学结果、治疗过程、社会经济结果和死亡率进行数据分析。
我们发现了15例坏死性筋膜炎患者。在观察期内无一例死亡。手术干预的平均次数为7次。两名患者接受了肢体截肢；糖尿病患者截肢风险显著更高。平均住院时间为32天，其中在重症监护病房住院8天。在发现的细菌中，93%对氨苄西林、克林霉素和科隆最初的抗生素治疗敏感。
如果怀疑有坏死性筋膜炎，应进行手术治疗。在我们的队列中，糖尿病是坏死性筋膜炎患者肢体截肢的临床预测因素。建议使用氨基青霉素±舒巴坦联合克林霉素和/或甲硝唑作为最初计算的抗生素治疗。
