SFGH 11.16 pearls: SSTIs!

  • Most patients with pyeomyositis have a normal CK, but necrotizing fasciitis is often associated with an elevated CK!
  • IV drug use is a risk factor for pyeomyositis, though usually due to local injection rather than hematogenous seeding
  • Wound cultures should only be obtained once a wound has been cleaned and debrided and deep tissue culture is preferable
  • While imaging is often obtained, surgical exploration is the only way to definitively diagnose or exclude necrotizing fasciitis, and imaging should not delay surgery if suspicion is high
    • If imaging is obtained, non-con CT is fastest and most useful for identifying gas in the tissue, which is a very specific but insensitive finding
  • Having an LRINEC score of >6 on admission should prompt urgent surgical evaluation for nec fasc, and the positive predictive value increases as the LRINEC score goes up up
  • A recent article showed evidence that the LRINEC score could more effectively risk stratify patients with possible necrotizing fasciitis if more weight was given to the CRP and exam factors, including pain, fever, AKI and tachycardia.

Evernote link: https://www.evernote.com/shard/s300/sh/414cd40b-3c21-4d31-bb6a-3a0025e56f5d/0300e34cf62f9fafc90d22f985255d59

Crum NF. Bacterial pyomyositis in the United States. Am J Med 2004; 117:420.

Armstrong DG, Lipsky BA. Advances in the treatment of diabetic foot infections. Diabetes Technol Ther 2004; 6:167.

Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis 2007; 44:705.

Borschitz T, et al. Improviement of a clinical score for necrotizing fasciitis: “Pain out of proportion” and high CRP level aid the diagnosis. PLoS One 2015 Jul 21;10(7):e0132775.

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