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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]
Appears in following Topics:
Pressure Ulcers/Injuries - Introduction and Assessment