Trauma and Orthopedic Surgery, BG Unfallklinik Murnau, Murnau, Germany.
Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria.
Int Wound J. 2023 Dec;20(10):4235-4243. doi: 10.1111/iwj.14325. Epub 2023 Aug 30.
Necrotizing soft tissue infections (NSTIs) represent similar pathophysiological features, but the clinical course might range from subacute to a rapidly progressive, fulminant sepsis. Initial wound microbiology is the base for the Guiliano classification. The timeline of microbiological colonization has not been described during the clinical course. The role of the different microbiological pathogens on the outcome and mortality is unclear. One hundred eighty patients were included with septic inflammation response syndrome on admission. Initial wound microbiology and the changes in wound microbiology were analysed during the clinical course and correlated with outcome and risk indicators. Overall mortality was 35%. Higher age, a high Charlson Comorbidity Index or ASA score and truncal infections were highly prognostic for a lethal outcome. Microbiological findings revealed significant differences in the persistence of bacteria during the course of disease. Streptococci were only detectable within the first 5 days, whereas other bacteria persisted over a longer period of time. Initial microbiological findings correlated with better prognosis when no causative agent was identified and for gram-negative rods. Varying survival rates were observed for different Streptococci, Staphylococci, Enterococci and other bacteria. The highest odds ratio for a lethal outcome was observed for Enterococci and fungi. Microbiological colonization changes during the clinical course of NSTIs and some microbiologic pathogens are predictive for worsening the outcome and survival. Streptococcus pyogenes is only detectable in the very early phase of NSTI and after 6 days not anymore detectable. Later Enterococci and fungi showed the highest odds ratios for a lethal outcome. Enterococci bacteria and fungi have yet not been considered of clinical relevance in NSTI or even as indicator for worsening the outcome.
坏死性软组织感染 (NSTIs) 具有相似的病理生理特征，但临床过程可能从亚急性到迅速进展的暴发性脓毒症不等。初始伤口微生物学是 Guiliano 分类的基础。微生物定植的时间进程在临床过程中尚未描述。不同微生物病原体对结果和死亡率的影响尚不清楚。入院时，180 例患者符合败血症炎症反应综合征。分析了初始伤口微生物学和临床过程中伤口微生物学的变化，并与结果和风险指标相关。总体死亡率为 35%。较高的年龄、较高的 Charlson 合并症指数或 ASA 评分和躯干感染与致命结局高度相关。微生物学发现显示，在疾病过程中细菌的持续存在存在显著差异。链球菌仅在最初的 5 天内可检测到，而其他细菌则持续存在更长时间。当未发现病原体时，初始微生物学发现与更好的预后相关，革兰氏阴性杆菌也是如此。不同链球菌、葡萄球菌、肠球菌和其他细菌的存活率差异很大。肠球菌和真菌的致死风险比最高。NSTIs 临床病程中微生物定植的变化和一些微生物病原体可预测预后恶化和生存。化脓性链球菌仅在 NSTI 的早期阶段和 6 天后才可检测到，之后不再可检测到。随后肠球菌和真菌的致死风险比最高。肠球菌细菌和真菌尚未被认为与 NSTI 相关，甚至也不是预示预后恶化的指标。
