Department of Critical Care, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
Service de Réanimation Médicale, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France; Groupe de Recherche Clinique CARMAS, Université Paris-Est Créteil, IMRB, Créteil, France.
Clin Microbiol Infect. 2020 Jan;26(1):8-17. doi: 10.1016/j.cmi.2019.06.031. Epub 2019 Jul 5.
Necrotizing skin and soft-tissue infections (NSTI) are rare but potentially life-threatening and disabling infections that often require intensive care unit admission.
To review all aspects of care for a critically ill individual with NSTI.
Literature search using Medline and Cochrane library, multidisciplinary panel of experts.
The initial presentation of a patient with NSTI can be misleading, as features of severe systemic toxicity can obscure sometimes less impressive skin findings. The infection can spread rapidly, and delayed surgery worsens prognosis, hence there is a limited role for additional imaging in the critically ill patient. Also, the utility of clinical scores is contested. Prompt surgery with aggressive debridement of necrotic tissue is required for source control and allows for microbiological sampling. Also, prompt administration of broad-spectrum antimicrobial therapy is warranted, with the addition of clindamycin for its effect on toxin production, both in empirical therapy, and in targeted therapy for monomicrobial group A streptococcal and clostridial NSTI. The role of immunoglobulins and hyperbaric oxygen therapy remains controversial.
Close collaboration between intensive care, surgery, microbiology and infectious diseases, and centralization of care is fundamental in the approach to the severely ill patient with NSTI. As many aspects of management of these rare infections are supported by low-quality data only, multicentre trials are urgently needed.
坏死性皮肤和软组织感染（NSTI）罕见但具有潜在生命威胁和致残性，常需入住重症监护病房。
综述 NSTI 重症患者的所有治疗相关内容。
使用 Medline 和 Cochrane 图书馆进行文献检索，多学科专家小组。
NSTI 患者的初始表现可能具有误导性，因为严重全身中毒的特征可能掩盖了有时不太明显的皮肤表现。感染可能迅速扩散，延迟手术会使预后恶化，因此重症患者的额外影像学检查作用有限。此外，临床评分的作用也存在争议。为了进行源头控制和允许进行微生物采样，需要进行积极的清创手术，以清除坏死组织。还应立即给予广谱抗菌治疗，并在经验性治疗和针对单一致病菌性 A 组链球菌和梭状芽孢杆菌 NSTI 的靶向治疗中添加克林霉素，以发挥其对毒素产生的作用。免疫球蛋白和高压氧治疗的作用仍存在争议。
重症监护、外科、微生物学和传染病学之间的密切协作以及集中治疗是治疗 NSTI 重症患者的基础。由于这些罕见感染的许多治疗方法仅得到低质量数据的支持，因此迫切需要开展多中心试验。
