Skin and Soft Tissue Infections in the Surgical Area at the Kara Teaching Hospital

Objective: To report the management of skin and soft tissue infections in the surgical area of Kara University Hospital in Togo. Material and Methods: This study was conducted retrospectively from January 1, 2021, to December 31, 2022, in the general surgery and orthopedic trauma departments. The study focused on soft tissue infections of the pelvic and thoracic limbs and analyzed epidemiological, clinical, paraclinical, therapeutic, and evolutionary data. Results: We registered 165 patients, comprising 109 men and 56 women.The sex ratio (F/H) were 0.51. The mean age was 45 years with extremes ranging from 23 to 90 years. Farmers (64.8%) followed by housewives (34.0%) were the social strata most affected. The consultation period varied between 1 and 90 days. The pathologies found were necrotizing fasciitis (53.3%), erysipelas (18.2%), infected limb wounds (12.1%), pyomyositis (9.7%), and necrotizing dermo-hypodermitis (1.8%). The main procedures performed were necrosectomy and grafting (62.9%), sample necrosectomy (18.8%), drainage (9.7%), and pelvic limb amputation (1.2%). Follow-up was favorable in 86.7% of cases. The study noted a death rate of 13.3% due to septic shock secondary to a delay in consultation. Conclusion: Skin and soft tissue infections were a common reason for surgical hospitalization at Kara University Hospital, with a high mortality rate due to delayed consultations.

Chronic Pain Management after Necrotizing Soft Tissue Infection (NSTI): A Case Report

Background: Necrotizing soft tissue infections (NSTIs) are potentially life threatening medical emergencies associated with devastating and rapidly spreading destruction of soft tissues. Atypical presentations and delayed early diagnosis can be significant challenges in managing NSTIs. The infectious process can start at any part of the body with rapid progression leading to limb amputation and high mortality rate. We present a case of a patient with NSTI, the sequelae and management of the chronic pain that developed. Aim: This case report looks to shed light on the importance of a plan for management of subacute and chronic pain in treating patients who present with Necrotizing soft tissue infection. Case presentation: A 53-year-old female who presented with septicemia and was subsequently admitted and treated for NSTI in 2014 resulting in amputation of her distal foot, toe digits, and now with ongoing chronic wound of the lower extremities along with chronic pain. Conclusion: Chronic pain as part of the sequelae of Necrotizing soft tissue infections needs to be anticipated by the health care management team in order to optimize patient care post operatively.

Characteristics of Children Referred for Drainage of Sub-cutaneous Soft Tissue Infections

Purpose: Severe skin and soft tissue infections in children are a common cause of hospital admission. Surgical drainage is often required for definitive therapy. Our aim was to review common characteristics of children requiring surgical incision and drainage (I&D) for subcutaneous abscesses. Methods: IRB approval was obtained for a retrospective chart review of children requiring I&D of subcutaneous abscesses between July 2006 and June 2011. Data points included patient demographics, abscess location, surgical procedure, microbiology cultures, and hospital length of stay. Results: Surgical I&D were performed on 1042 children, and 781 patients (75%) were admitted to the surgical service. The average age was 3.4 years. 605 patients (58%) were female. 637 abscesses (61%) were located in the groin/buttock/perineum area. Methicillin-resistant Staphylococcus aureus (MRSA) was identified in 70% of the culture specimens. The average length of stay was 2.8 days. The rate of recidivism was 10.9%. Conclusions: Soft tissue infections requiring hospital admission and I&D are common in the pediatric population. The vast majority of these are due to MRSA infections. Infections requiring drainage most frequently occurred in the diaper area of girls less than 3 years old. A significant number of children have recurrent skin infections and represent an important patient subpopulation.

Necrotizing Soft Tissue Infections of the Male and Female Breast: A Literature Review

Background: Within the spectrum of necrotizing soft tissue infections (NSTI), necrotizing fasciitis (NF) has been characterized by tissue and fascial necrosis with systemic toxicity. The objective was to determine and summarize the frequency and characteristics of breast NF and NSTI in the literature. Methods: Cases were obtained through PubMed, Google Scholar, Google, and from published article reference sections. One hundred twenty-three cases were gleaned from 96 articles that reported NF and NSTI of the breast (1924 through 2021). Results: NF was reported in 70 and NSTI in 53 cases (111 women and 12 men). Patients presented with swollen, painful breasts, erythema, bullae, crepitus, necrosis, gangrene, fever, tachycardia, and neutrophilia. Fifty-nine of 123 (48.4%) patients were septic on admission. The most frequent microorganisms were β hemolytic Group A Streptococcus, and Staphylococcus aureus. Treatment consisted of antibiotics, mastectomy and debridement with flaps, skin grafts or primary and secondary closure. Forty-four (63.0%) of the NF cases had chest wall involvement;of these, 18 (14.6%) involved the breast secondarily, P < 0.0001. There were twelve mortalities (9.8%): eleven (9.0%) with NF and one (0.8%) with NSTI, P = 0.007. Conclusions: Men and women with breast NF and NSTI presented with similar signs and symptoms and required the same emergent treatment as provided for NF and NSTI of the more common sites. As a time-sensitive disease, patients treated within 12 hours of admission had a better survival. Patients with NF were more likely to have sepsis on admission, a higher mortality, and fascial chest wall/muscle involvement than patients with NSTI.

The ever-changing microenvironment of Staphylococcus aureus in cutaneous infections

Background:Staphylococcus aureus is responsible for the majority of skin and soft tissue infections,which are often diagnosed at a late stage,thereby impacting treatment efficacy.Our study was designed to reveal the physiological changes at different stages of infection by S.aureus through the combined analysis of variations in the skin microenvironment,providing insights for the diagnosis and treatment of S.aureus infections.Methods:We established a murine model of skin and soft tissue infection with S.aureus as the infectious agent to investigate the differences in the microenvironment at different stages of infection.By combining analysis of the host immune status and histological observations,we elucidate the progression of S.aureus infection in mice.Results:The results indicate that the infection process in mice can be divided into at least two stages:early infection(1–3 days post-i nfection)and late infection(5–7 days post-i nfection).During the early stage of infection,notable symptoms such as erythema and abundant exudate at the infection site were observed.Histological examination revealed infiltration of numerous neutrophils and bacterial clusters,accompanied by elevated levels of cytokines(IL-6,IL-10).There was a decrease in microbial alpha diversity within the microenvironment(Shannon,Faith's PD,Chao1,Observed species,Simpson,Pielou's E).In contrast,during the late stage of infection,a reduction or even absence of exudate was observed at the infected site,accompanied by the formation of scabs.Additionally,there was evidence of fibroblast proliferation and neovascularization.The levels of cytokines and microbial composition gradually returned to a healthy state.Conclusion:This study reveals synchrony between microbial composition and histological/immunological changes during S.aureus-i nduced SSTIs.

Soft tissue tuberculosis detected by next-generation sequencing:A case report and review of literature

BACKGROUND Soft tissue tuberculosis is rare and insidious,with most patients presenting with a localized enlarged mass or swelling,which may be factors associated with delayed diagnosis and treatment.In recent years,next-generation sequencing has rapidly evolved and has been successfully applied to numerous areas of basic and clinical research.A literature search revealed that the use of next-generation sequencing in the diagnosis of soft tissue tuberculosis has been rarely reported.CASE SUMMARY A 44-year-old man presented with recurrent swelling and ulcers on the left thigh.Magnetic resonance imaging suggested a soft tissue abscess.The lesion was surgically removed and tissue biopsy and culture were performed;however,no organism growth was detected.Finally,Mycobacterium tuberculosis was confirmed as the pathogen responsible for infection through next-generation sequencing analysis of the surgical specimen.The patient received a standardized anti-tuberculosis treatment and showed clinical improvement.We also performed a literature review on soft tissue tuberculosis using studies published in the past 10 years.CONCLUSION This case highlights the importance of next-generation sequencing for the early diagnosis of soft tissue tuberculosis,which can provide guidance for clinical treatment and improve prognosis.

Severe monobacterial necrotizing soft tissue infection by group A Streptococcus:A surgical emergency

Eight percent of necrotizing soft tissue infections(NSTI) are attributable to group A Streptococci(GAS),and among these,50%develop streptococcal toxic shock syndrome.The reported mortality associated with NSTI reaches 32%.We present cases of two healthy individuals with minor GAS skin infection which developed to a rapidly progressed NSTI and sepsis despite of the antibiotic treatment,aiming to discuss the lessons learned from the course and management of these patients.

The clinical characteristics and risk factors for necrotizing soft tissue infection in children

Importance:Necrotizing soft tissue infection(NSTI)is a serious infectious disease.However,the early clinical manifestations and indicators of NSTI in children are still unclear.Objective:The purpose of this study was to analyze the clinical characteristics and risk factors of NSTI in pediatric patients.Methods:A total of 127 children with skin and soft tissue infection(SSTI)were treated at our hospital and divided into two groups:the NSTI group and the non-NSTI group,based on their discharge diagnosis from January 2011 to December 2022.Then,we collected and analyzed the clinical characteristics and risk factors of all patients,including sex and age,disease inducement,admission temperature,local skin manifestations,infection site,the presence of sepsis,bacterial culture,and laboratory indicators.Results:In our study,there was a statistical difference in the age distribution and disease inducement between NSTI and non-NSTI groups.The occurrence of local skin manifestations(blisters/bullae and ecchymosis)and the presence of sepsis significantly increased in the NSTI group compared to the non-NSTI group.Additionally,only the platelet count on laboratory tests was statistically different between the NSTI and non-NSTI groups.Finally,the logistic regression analysis suggested that local skin manifestations such as blisters/bullae,and ecchymosis,as well as the presence of sepsis,were identified as risk factors for NSTI.Interpretation:Children with SSTI and skin manifestations such as blisters/bullae,ecchymosis,and the presence of sepsis are at a higher risk of developing NSTI.These symptoms serve as useful indicators for early detection of NSTI.

Characterization of <i>Staphylococcus aureus</i>infections among children in an outpatient clinic, China

Objective: We aimed to investigate the epidemiology and identify antibiotic resistance patterns of isolates from children with skin and soft tissue infections attending an outpatient clinic in Southern China. Method: An observational study of outpatient pediatric patients was conducted in a rural area of Guangxi. Infections were characterized in 230 patients and staphylococcal isolates tested for susceptibility to a range of antibiotics. Results: Among the 307 patients, 38.5% were infants. Culture yielded Staphylococcus aureus (S. aureus) in 230 patients, of which 24 (10.4%) were methicillin-resistant S. aureus (MRSA). Staphylococcal strains were most isolated from hand, foot and umbilicus. The 1-12 mon group had the highest staphylococcal infection rate (86%), followed by the 6-12 year group, but MRSA was more common in the older children (19.5% of S. aureus). MRSA had significantly more resistance than MSSA to chloromycin (46% vs 11%), clindamycin (67% vs 19%), gentamicin (33% vs 2%), rifampicin (25% vs 2.9%), and sulphamthoxazole-trimethoprim (17% vs 3%). Conclusion: S. aureus remains a leading cause of pediatric skin and soft tissue infections. Over 10% of isolates were methicillin-resistant with high rates of resistance to non-beta lactam antibiotics, reducing options for therapy and limiting choices for empirical treatment.

Aeromonas hydrophila infection in acute myeloid leukemia: A case report

Rationale:Aeromonas hydrophila,a bacterium commonly found in a variety of soils,aquatic habitats,and other natural environments,is known for causing infections and hemorrhagic diseases in both aquatic and terrestrial animals.Patients with leukemia,when infected by Aeromonas hydrophila following chemotherapy,face an increased risk of developing necrotizing fasciitis.Patient concerns:A 48-year-old male with a history of acute myeloid leukemia presented with swelling and pain in his right hand after being stabbed by a grass carp two days ago.The injury occurred on the fifth day after his last chemotherapy session when he was accidentally punctured in the right thumb and ring finger by a carp while fishing.Two days following the injury,the skin isurrounding the wound turned black immediately,while the rest of his hand was reddened,swollen,and bleeding.Diagnosis:Aeromonas hydrophila infection in the soft tissue of the right hand.Interventions:Intravenous antibiotics and local debridement.Outcomes:The patient experienced an alleviation of systemic poisoning symptoms,effective control of the local wound infection.Lessons:It is important for physicians to appreciate the potential for highly unusual and life-threatening infections in patients with acute myeloid leukemia.Early diagnosis and prompt treatment can prevent the development of necrotizing fasciitis and save patients’lives.

Treatment of infected soft tissue loss

Hand coverage in infected soft tissue loss(STL)is a challenging clinical condition.Appropriate and well-timed antibiotic therapy and careful debridement are crucial for the success of the subsequent reconstructive procedure.Debridement must be radical,and all nonviable or infected tissue should be removed.Strict medical control and multiple procedures can be required when infection recurrence is observed after primary procedure.Secondary healing of STL is usually necessary in these complex conditions.Negative pressure wound therapy(NPWT)is often used as a temporary instrument to reduce oedema and drainage,facilitating the attainment of a clean wound for subsequent reconstruction.According to the type and size of the defect,multiple options ranging from skin grafts and substitutes to local and free flaps can be selected for the treatment of infected STL.A reconstructive ladder approach and case-by-case decision making should always be considered.Due to the unique function and role of the hand,the surgical strategy must also take into account aesthetic and functional factors.Orthopedic and Plastic surgeons should manage this wide variety of treatment options in a multidisciplinary and high-specialized context including radiologists,microbiologists,infectious disease specialists and physiotherapists,customizing the treatment path to the specific patient's situation.

肝硬化失代偿期患者皮肤感染致脓毒性休克的护理

总结1例肝硬化失代偿期患者皮肤软组织非特异性感染致脓毒性休克的护理体会。护理要点:以目标平均动脉压为导向,实施液体复苏;加强全程营养管理,加速创面修复;肝硬化失代偿期间,出血与血栓防范护理;加强院感管理,预防院内感染。经过45 d个性化的治疗和护理,双下肢植皮存活,无院内感染发生,患者康复出院。

急诊入院整形美容技术修复146例头面部软组织损伤患者的护理体会

目的总结急诊入院整形美容技术修复146例头面部软组织损伤患者的护理经验。方法选择2023年4月至2023年12月焦作市第二人民医院急诊科收治的146例头面部软组织损伤患者作为研究对象;创面类型为单处线性118例,单处缺损15例,多处创伤11例,贯穿伤2例。患者入院时做好评估,给予个性化心理护理缓解其不良情绪,术前向患者介绍整形美容技术的特点、费用,术中做好配合,术后做好创面护理和皮瓣护理,院外延续性护理对患者饮食和创面护理进行指导。结果单处线性创伤118例患者,均一期愈合,术后9例遗留瘢痕,切口长度均≥5 cm;单处缺损15例,2例患者缺损面积较大,需进行二期肉芽创面植皮,为二期愈合;其余13例均为1期愈合,3例患者遗留瘢痕。多处创伤11例,均一期愈合,未见遗留明显瘢痕。贯穿伤2例患者均一期愈合,未遗留瘢痕。结论整形美容技术是急诊科修复头面部软组织损伤的主要方式,对术前评估和针对性的心理护理、术前沟通,可促进患者对整形美容技术的理解和应用,术后护理和延续性护理,可保证术后修复美容效果。

Molecular Epidemiology of Staphylococcus aureus among Patients with Skin and Soft Tissue Infections in Two Chinese Hospitals

Background：Staphylococcus aureus is one of the predominant causes of skin and soft tissue infections （SSTIs）,but limited data were available regarding the characterization of S.aureus from SSTIs patients in Jiangsu Province in China.We aimed to investigate the molecular epidemiology ofS.aureus among SSTIs patients in two hospitals of Jiangsu Province.Methods：Sixty-two patients with SSTIs from two Chinese hospitals in Jiangsu Province were enrolled in this study,and 62 S.aureus isolates were collected from February 2014 to January 2015.S.aureus isolates were characterized by antimicrobial susceptibility testing,toxin gene detection,and molecular typing with sequence type,Staphylococcus protein A gene type,accessorygeneregulator（agr）group,and Staphylococcal cassette chromosome mec type.Results：Sixteen （25.8%） methicillin-resistant S.aureus （MRSA） isolates were detected,and there was no isolate found resistant to vancomycin,teicoplanin,sulfamethoxazole-trimethoprim,and linezolid.The sei was the toxin gene most frequently found,and no lukS/F-PV-positive isolates were detected among the SSTIs＆#39; patients.Molecular analysis revealed that ST398 （10/62,16.1%;2 MRSA and 8 methicillin-susceptible S.aureus） to be the dominant clone,followed by ST5 （8/62,12.9%） and ST7 （8/62,12.9%）.Conclusions：The livestock ST398 was the most common clone among patients with S.aureus SSTIs in Jiangsu Province,China.Surveillance and further studies on the important livestock ST398 clone in human infections are necessarily requested.

手部软组织缺损皮瓣修复术围术期护理干预效果分析

目的:分析手部软组织缺损皮瓣修复术围术期护理干预效果。方法:选取2021年1月—2023年5月滨州医学院附属医院收治的手部软组织缺损患者200例为研究对象,均接受皮瓣修复术治疗,随机分为对照组和观察组,各100例。对照组采用常规护理,观察组采用围术期护理。比较两组手部功能障碍发生率、日常活动能力[日常生活活动能力量表(ADL)评分]、并发症发生率。结果:观察组手部功能障碍发生率低于对照组,差异有统计学意义(P=0.009)。护理前,两组ADL评分比较,差异无统计学意义(P>0.05),护理后,两组ADL评分高于护理前,观察组高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P=0.017)。结论:围术期护理干预能降低手部软组织缺损皮瓣修复术患者术后手部功能障碍发生率及并发症发生率,提高日常生活能力。

负压引流辅助治疗骨与软组织感染的机制

背景:随着国内人口老龄化进程的加快,骨与软组织感染的发病率也随之升高。骨与软组织感染可累及包括骨膜、骨皮质、骨松质和骨髓在内的所有骨组织及周围软组织,如糖尿病足、骨髓炎、手术切口感染和关节假体周围感染等均属此范畴,由于其发病机制复杂且治疗困难,因而越来越受到临床关注。负压创面治疗技术是近年来用于伤口治疗的新兴技术,尤其在骨与软组织感染领域疗效显著。目的:综述近年国内外负压创面治疗技术治疗骨与软组织感染的研究进展。方法:检索1990-2022年在PubMed、Web of Science数据库和中国知网发表的相关中英文文献,英文检索词“negative pressure wound therapy,vacuum assisted closure,negative pressure,osteomyelitis,bone infection”;中文检索词“负压伤口疗法,局部负压疗法,负压包扎,负压封闭技术,机械力,骨髓炎,骨感染”。共检索到711篇相关文献,其中65篇文献符合纳入标准。结果与结论:①负压创面治疗技术作为一种创面辅助治疗方式,相对于单一作用的传统敷料,其稳定创面、减轻水肿、降低细菌载荷、刺激肉芽组织和血管生成、改善组织灌注、调控末梢神经、调节生物免疫、促进成骨细胞增殖和分化的多重作用机制,能够更好地管理骨与软组织感染等复杂创面;②现有的大量基础及临床研究结果表明负压创面治疗技术在辅助治疗骨与软组织感染中具有显著的安全性及有效性。

腹膜透析导管出口周围疖肿的发生情况及影响因素分析

目的探讨腹膜透析(peritoneal dialysis,PD)导管出口周围疖肿的发生情况及影响因素。方法选择2011年9月─2017年9月北京大学人民医院肾内科规律随访的PD患者,回顾其PD导管出口周围疖肿的发生情况及临床资料,分析其相关影响因素。结果183名PD患者入选研究,男性88例(占48.1%),平均年龄(59.8±13.8)岁,透析龄27(15,51)月。其中23名(12.6%)患者发生36例次出口周围疖肿,发生率0.05次/风险年。14例次(占38.9%)患者疖肿发生部位以PD导管为中心、周围6~9点的位置。并发症方面:4例次(占11.1%)疖肿合并出口和/或隧道感染,无合并腹膜炎。Logistic回归分析结果显示:透析龄(OR=0.969,95%CI:0.941~0.998,P=0.039)、合并糖尿病(OR=3.014,95%CI:1.050~8.651,P=0.040)、血C反应蛋白(OR=1.154,95%CI:1.065~1.251,P<0.001)是PD患者出口周围发生疖肿的独立危险因素。通过Logistic回归分析PD患者出口疖肿频发的相关因素,结果显示合并糖尿病(OR=5.513,95%CI:1.029~29.536,P=0.046)、C反应蛋白(OR=1.103,95%CI:1.016~1.197,P=0.019)是出口周围疖肿频发的独立危险因素。结论PD导管出口周围疖肿形成在PD患者中并不少见,可能发展为出口感染和/或隧道感染。对合并糖尿病、透析龄较短、C反应蛋白水平高的患者应重点关注出口周围疖肿的发生,并给予相应的预防宣教,从而预防出口和/或隧道感染。

Risk stratification system for skin and soft tissue infections after allogeneic hematopoietic stem cell transplantation:PAH risk score

Skin and soft tissue infections(SSTIs)refer to infections involving the skin,subcutaneous tissue,fascia,and muscle.In transplant populations with hematological malignancies,an immunocompromised status and the routine use of immunosuppressants increase the risk of SSTIs greatly.However,to date,the profiles and clinical outcomes of SSTIs in hematopoietic stem cell transplantation(HSCT)patients remain unclear.This study included 228 patients(3.67%)who developed SSTIs within 180 days after allogeneic HSCT from January 2004 to December 2019 in Peking University People’s Hospital.The overall annual survival rate was 71.5%.We compared the differences between survivors and non-survivors a year after transplant and found that primary platelet graft failure(PPGF),comorbidities of acute kidney injury(AKI),and hospital-acquired pneumonia(HAP)were independent risk factors for death in the study population.A PPGF-AKI-HAP risk stratification system was established with a mortality risk score of 1×PPGF+1×AKI+1×HAP.The areas under the curves of internal and external validation were 0.833(95%CI 0.760–0.906)and 0.826(95%CI 0.715–0.937),respectively.The calibration plot revealed the high consistency of the estimated risks,and decision curve analysis showed considerable net benefits for patients.

马红球菌感染致菌血症1例

马红球菌作为一种可以感染人畜的胞内致病菌,在自然界土壤、动物粪便等环境中分布广泛,易导致牛、猪、马等动物患病,而引起人类感染相对罕见,偶见于免疫缺陷、农牧业职业暴露史群体。本文报导1例马红球菌感染所致的左下肢软组织感染并脓肿形成、菌血症,经局部清创术及有效抗感染治疗后治愈。

腰椎后路手术后病人软组织源性疼痛护理干预需求的质性研究

目的:评估腰椎后路手术后病人对软组织源性疼痛干预的需求,为病人术后软组织源性疼痛护理干预方案的构建提供依据。方法:采用目的抽样法选取2022年3月-10月在南通市第一人民医院脊柱外科住院符合标准的腰椎后路手术病人进行面对面半结构化访谈,采用Colaizzi现象学分析法进行资料分析。结果:总结导致腰椎后路手术病人术后软组织源性疼痛护理干预的障碍因素,归纳为躯体障碍因素、认知障碍因素、信息障碍因素及环境障碍因素4个主题及11个亚主题。结论:腰椎后路手术病人对术后软组织源性疼痛的认知及干预意识不足,缺乏系统、科学的疼痛护理干预方案,护理人员应结合腰椎后路手术病人术后软组织源性疼痛护理干预的障碍因素开展针对性护理,满足病人对疼痛干预的需求。