Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, 613, Chiayi County, Taiwan.
Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, No.2, Sec. W., Jiapu Rd., Puzi City, 613, Chiayi County, Taiwan.
World J Emerg Surg. 2022 Jan 8;17(1):1. doi: 10.1186/s13017-022-00404-4.
We conducted this study to evaluate the characteristics of the infectious fluid in soft tissue infection and investigate the utility of the biochemical tests and Gram stain smear of the infectious fluid in distinguishing necrotizing soft tissue infection (NSTI) from cellulitis.
This retrospective cohort study was conducted in a tertiary care hospital in Taiwan. From April 2019 to October 2020, patients who were clinically suspected of NSTI with infectious fluid accumulation along the deep fascia and received successful ultrasound-guided aspiration were enrolled. Based on the final discharge diagnosis, the patients were divided into NSTI group, which was supported by the surgical pathology report, or cellulitis group. The t test method and Fisher's exact test were used to compare the difference between two groups. The receiver-operator characteristic (ROC) curves and area under the ROC curve (AUC) were used to evaluate the discriminating ability.
Total twenty-five patients were enrolled, with 13 patients in NSTI group and 12 patients in cellulitis group. The statistical analysis showed lactate in fluid (AUC = 0.937) and LDH in fluid (AUC = 0.929) had outstanding discrimination. The optimal cut-off value of fluid in lactate was 69.6 mg/dL with corresponding sensitivity of 100% and specificity of 76.9%. The optimal cut-off value of fluid in LDH was 566 U/L with corresponding sensitivity of 83.3% and a specificity of 92.3%. In addition, albumin in fluid (AUC = 0.821), TP in fluid (AUC = 0.878) and pH in fluid (AUC = 0.858) also had excellent diagnostic accuracy for NSTI. The Gram stain smear revealed 50% bacteria present in NSTI group and all the following infectious fluid culture showed bacteria growth.
The analysis of infectious fluid along the deep fascia might provide high diagnostic accuracy to differentiate NSTI from cellulitis.
本研究旨在评估软组织感染中感染性液体的特征，并探讨感染性液体的生化检测和革兰氏染色在鉴别坏死性软组织感染（NSTI）与蜂窝织炎中的作用。
本研究为回顾性队列研究，在台湾一家三级医院进行。2019 年 4 月至 2020 年 10 月，对临床疑似深筋膜内有感染性积液积聚并接受超声引导下成功抽吸的 NSTI 患者进行了研究。根据最终出院诊断，将患者分为 NSTI 组（支持外科病理学报告）和蜂窝织炎组。采用 t 检验和 Fisher 确切检验比较两组间的差异。采用受试者工作特征（ROC）曲线和 ROC 曲线下面积（AUC）评价鉴别能力。
共纳入 25 例患者，其中 NSTI 组 13 例，蜂窝织炎组 12 例。统计分析显示，积液中的乳酸（AUC=0.937）和 LDH（AUC=0.929）具有出色的鉴别能力。乳酸最佳截断值为 69.6mg/dL，其灵敏度为 100%，特异性为 76.9%。LDH 的最佳截断值为 566U/L，其灵敏度为 83.3%，特异性为 92.3%。此外，积液中的白蛋白（AUC=0.821）、总蛋白（AUC=0.878）和 pH 值（AUC=0.858）对 NSTI 也具有良好的诊断准确性。革兰氏染色显示，NSTI 组 50%的感染性液体中存在细菌，所有后续的感染性液体培养均显示细菌生长。
分析深筋膜内的感染性液体可能为鉴别 NSTI 与蜂窝织炎提供较高的诊断准确性。
