Mizokami F, Furuta K, Isogai Z, et al.
Journal of tissue viability. Date of publication 2014 Feb 1;volume 23(1):1-6.
1. J Tissue Viability. 2014 Feb;23(1):1-6. doi: 10.1016/j.jtv.2013.11.001. Epub 2013
Dec 8.
Necrotizing soft tissue infections developing from pressure ulcers.
Mizokami F(1), Furuta K(2), Isogai Z(3).
Author information:
(1)Department of Pharmacy, National Center for Geriatrics and Gerontology, Japan.
(2)Department of Pharmacy, National Center for Geriatrics and Gerontology, Japan;
Department of Clinical Research and Development, National Center for Geriatrics
and Gerontology, Japan.
(3)Division of Dermatology and Connective Tissue Medicine, Department of Advanced
Medicine, National Center for Geriatrics and Gerontology, Japan. Electronic
address: zenzo@ncgg.go.jp.
AIM OF THE STUDY: Necrotizing soft tissue infections (STIs) are serious
complications that may arise from pressure ulcers. However, there are few studies
on this important issue. In addition, diagnostic criteria for necrotizing STIs
developing from pressure ulcers and infected pressure ulcers are not well
established.
METHODS: We defined necrotizing STIs developing from pressure ulcers based on
clinical findings. Based on the definition, we retrospectively analyzed the
medical records of 24 elderly patients with this condition to determine patient
age, gender, comorbid disease, laboratory findings, wound location, bacteriology,
and treatment outcomes.
RESULTS: In the examined population, necrotizing STIs developed primarily from
pressure ulcers over the sacrum. Dementia and diabetes mellitus were also
frequently observed in patients with necrotizing STIs. The average Laboratory
Risk Indicator for Necrotizing Fasciitis (LRINEC) score was relatively low.
Bacterial cultures from the debrided deep tissues exhibited mixed infections of
gram-positive cocci and gram-negative bacilli, except 1 case. Anaerobic pathogens
were isolated from 18 patients (72%), and 7 patients (29%) developed bacteremia.
None of the cases were preceded by wounds dominated by granulation tissue.
Surgical intervention, combined with antibacterial therapy involving intravenous
carbapenem or cephem, was successfully used in most cases.
CONCLUSION: Necrotizing STIs arising from pressure ulcers are generally caused by
mixed pathogens and exhibit symptoms that are milder than those of necrotizing
fasciitis caused by group A Streptococcus.
Copyright © 2013 Tissue Viability Society. Published by Elsevier Ltd. All rights
reserved.
DOI: 10.1016/j.jtv.2013.11.001
PMID: 24360717 [Indexed for MEDLINE]
