Hua Camille, Urbina Tomas, Bosc Romain, Parks Tom, Sriskandan Shiranee, de Prost Nicolas, Chosidow Olivier
Service de Dermatologie, Assistance Publique-Hôpitaux de Paris, Créteil, France; Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France; Epidemiology in Dermatology and Evaluation of Therapeutics, Université Paris Est Créteil, Créteil, France; Groupe Infectiologie Dermatologique-Infections Sexuellement Transmissibles, Société Française de Dermatologie, Paris, France.
Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.
Lancet Infect Dis. 2023 Mar;23(3):e81-e94. doi: 10.1016/S1473-3099(22)00583-7. Epub 2022 Oct 14.
The incidence of necrotising soft-tissue infections has increased during recent decades such that most physicians might see at least one case of these potentially life-threatening infections in their career. Despite advances in care, necrotising soft-tissue infections are still associated with high morbidity and mortality, underlining a need for continued education of the medical community. In particular, failure to suspect necrotising soft-tissue infections, fuelled by poor awareness of the disease, promotes delays to first surgical debridement, amplifying disease severity and adverse outcomes. This Review will focus on practical approaches to management of necrotising soft-tissue infections including prompt recognition, initiation of specific management, exploratory surgery, and aftercare. Increased alertness and awareness for these infections should improve time to diagnosis and early referral to specialised centres, with improvement in the prognosis of necrotising soft-tissue infections.
近几十年来，坏死性软组织感染的发病率有所上升，以至于大多数医生在其职业生涯中可能至少会遇到一例这类潜在危及生命的感染病例。尽管在治疗方面取得了进展，但坏死性软组织感染仍然与高发病率和高死亡率相关，这突出表明需要对医学界进行持续教育。特别是，由于对该疾病认识不足而未能怀疑坏死性软组织感染，会导致首次手术清创延迟，加剧疾病严重程度和不良后果。本综述将重点关注坏死性软组织感染的实际管理方法，包括及时识别、启动特定治疗、探查性手术和术后护理。提高对这些感染的警觉性和认识应能缩短诊断时间并尽早转诊至专科中心，从而改善坏死性软组织感染的预后。
