Urbina Tomas, Razazi Keyvan, Ourghanlian Clément, Woerther Paul-Louis, Chosidow Olivier, Lepeule Raphaël, de Prost Nicolas
Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 75571 Paris, France.
Sorbonne Université, Université Pierre-et-Marie Curie, 75001 Paris, France.
Antibiotics (Basel). 2021 Sep 13;10(9):1104. doi: 10.3390/antibiotics10091104.
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.
坏死性软组织感染（NSTIs）是一种罕见的危及生命的细菌感染，其特征是皮肤和皮下组织广泛坏死。NSTIs的初始紧急处理依赖于广谱抗生素治疗、对所有感染组织进行快速手术清创，以及在存在相关器官功能衰竭时在重症监护病房进行治疗。NSTI患者的抗生素治疗面临几个挑战，并且应该：（1）由于频繁的多微生物感染，对革兰氏阳性和革兰氏阴性病原体具有广谱活性，在某些情况下考虑扩大对多重耐药性的覆盖范围。在实践中，广谱β-内酰胺抗生素（如哌拉西林-他唑巴坦）是经验性治疗的主要药物；（2）减少毒素产生，通常使用克林霉素联合用药，主要用于已证实或疑似A组链球菌感染；（3）鉴于局部灌注受损、组织坏死以及药代动力学和药效学改变，实现尽可能好的组织扩散。抗生素治疗的最佳持续时间尚未明确确定，一般为7至15天。本文综述了目前关于NSTIs抗生素使用的现有知识。
