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    Jurnal Reading Current Concept in The Management of Necrotizing Fasciitis

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    Erlin Irawati
    1) Necrotizing fasciitis is a serious bacterial infection that requires early diagnosis and treatment to prevent severe outcomes like amputation and death. 2) Diagnosis involves clinical signs and symptoms, laboratory tests, and imaging to determine the extent of infection and tissue damage. 3) Treatment is both antibiotic therapy targeted at the likely bacteria and urgent surgical debridement of infected and necrotic tissue.

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    Jurnal Reading Current Concept in The Management of Necrotizing Fasciitis

    Uploaded by

    Erlin Irawati
    42 views39 pages
    1) Necrotizing fasciitis is a serious bacterial infection that requires early diagnosis and treatment to prevent severe outcomes like amputation and death. 2) Diagnosis involves clinical signs and symptoms, laboratory tests, and imaging to determine the extent of infection and tissue damage. 3) Treatment is both antibiotic therapy targeted at the likely bacteria and urgent surgical debridement of infected and necrotic tissue.

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    jurnal necrotizing fasciitis

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    1) Necrotizing fasciitis is a serious bacterial infection that requires early diagnosis and treatment to prevent severe outcomes like amputation and death. 2) Diagnosis involves clinical signs and symptoms, laboratory tests, and imaging to determine the extent of infection and tissue damage. 3) Treatment is both antibiotic therapy targeted at the likely bacteria and urgent surgical debridement of infected and necrotic tissue.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    42 views39 pages

    Jurnal Reading Current Concept in The Management of Necrotizing Fasciitis

    Uploaded by

    Erlin Irawati
    1) Necrotizing fasciitis is a serious bacterial infection that requires early diagnosis and treatment to prevent severe outcomes like amputation and death. 2) Diagnosis involves clinical signs and symptoms, laboratory tests, and imaging to determine the extent of infection and tissue damage. 3) Treatment is both antibiotic therapy targeted at the likely bacteria and urgent surgical debridement of infected and necrotic tissue.

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    © All Rights Reserved
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    of 39

    JURNAL READING

    Current Concept in the Management


    Of Necrotizing Fasciitis
    Evangelos P. Misiakos*, George Bagias, Paul Patapis, Dimitrios Sotiropoulos,
    Prodromos Kanavidis and Anastasios Machairas

    Oleh:
    Agus Darmanto I11108067
    Erlin Irawati I11109059
    Rakhmiana I11109004
    Pembimbing:
    dr. Zainul Naim, Sp.B

    www.frontiersin.org September 2014 | Volume 1 |


    Article 36

    INTRODUCTION

    Necrotiz

    Early diagnosis is
    mandatory, any
    delay could prove
    fatal :
    - extensive
    surgery
    - higher rates of
    amputation
    - higher mortality
    rates
    - lead to (SIRS).

    EPIDEMIOLOGY

    ETIOLOGI
    Trauma

    ETIOLOGI
    Fourniers gangrene

    CO-MORBIDITIES AND RISK FACTOR


    Comorbidities

    PATHOPHYSIOLOGY

    PATHOPHYSIOLOGY

    PATHOPHYSIOLOGY
    The extension of the infection and
    necrosis is facilitated by the synergy
    between the different bacteria and
    toxins and the enzymes they produce
    An anaerobic environment promotes
    growth of anaerobic bacteria.
    Gas formed by anaerobic bacteria
    may lead to crepitus.

    MICROBIOLOGY

    DIAGNOSIS
    CLINICAL SIGNS AND SYMPTOMS
    BEDSIDE AND LABORATORY TESTS
    IMAGING TEST

    CLINICAL SIGNS AND


    SYMPTOMS

    CLINICAL SIGNS AND


    SYMPTOMS

    FULMINANT FORM
    - Early sign are

    CLINICAL SIGNS AND


    SYMPTOMS

    SUBACUTE FORM has a relatively slow clinical


    course, which may endure for days or weeks.
    Early phase

    CLINICAL SIGNS AND


    SYMPTOMS
    The infection develops

    BEDSIDE AND LABORATORY TESTS

    Leukocytosis (WBC count in excess of


    20,000/L is highly suspect).
    Blood urea nitrogen >18 mg/dL and
    serum creatinine >1.2 mg/dL reflect
    ongoing renal failure, which is typically
    present in these patients.
    Serum creatine kinase is also elevated
    (CK) inpatients with severe sepsis and
    MODS

    BEDSIDE AND LABORATORY TESTS


    LRINEC scoring system for early
    diagnosis
    The finger test and frozen section
    biopsycomplementary
    Surgical explorations
    Imaging (plain radiography, CT scan,
    MRI, combination
    USG) showing
    The
    ofgas formtion

    BEDSIDE AND LABORATORY TESTS

    IMAGING

    Plain radiography showing gas


    formation in soft tissue
    CT Scan & MRI show the extent of
    tissue infection, fascial swelling,
    inflammation, and gas formation
    USGhyperechoic foci with
    reverberation artifact and dirty
    shadowing at the site of infection,
    representing the subcutaneous gas

    TREATMENT
    ANTIBIOTIC TREATMENT
    SURGICAL MANAGEMENT
    USE OF VACUUM-ASSISTED
    CLOSURE DEVICE

    ANTIBIOTIC TREATMENT

    TYPE 1 INFECTION
    Antibiotic treatment of a polymicrobial infection
    should be based on history, Gram stain, and
    culture.
    Initial
    treatment
    includes
    ampicillin
    or
    ampicillinsulbactam
    combined
    with
    metronidazole or clindamycin .
    Anaerobic coverage is quite important for type 1
    infection:
    metronidazole,
    clindamycin,
    or
    carbapenems
    (imipenem)
    are
    effective
    antimicrobials.

    ANTIBIOTIC TREATMENT

    TYPE 2
    Antibiotics against S. pyogenes and S.
    Aureus first or second generation of
    cephalosporins (MSSA)
    MRSA vancomycin or daptomycin and
    linezolid in cases where S. aureus is
    resistant to vancomycin.

    ANTIBIOTIC TREATMENT

    TYPE 3
    Clindamycin and penicillin Clostridium
    species
    If Vibrioinfection is suspected, the early
    use
    of
    tetracyclines
    (including
    doxycycline and minocycline)and thirdgeneration cephalosporins is crucial for
    the survival of the patient.
    TYPE 4
    Amphotericin B or fluoroconazoles.

    ANTIBIOTIC TREATMENT
    Antibiotics should be administered for
    up to 5 days after local signs and
    symptoms have resolved.
    The mean duration of antibiotic
    therapy for NF is 46 weeks.

    SURGICAL MANAGEMENT

    Emergency surgical debridement of


    the affected tissues is the primary
    management modality for NF.
    Surgical debridement, necrosectomy,
    and fasciotomy are the main aspects of
    surgical treatment.

    SURGICAL MANAGEMENT

    Surgical management is indicated


    especially for patients displaying intense
    pain and skin color change, such as
    edema and/or ecchymoses, or signs of
    skin ischemia with blisters and bullae.
    Patients must be operated on urgently
    when they present with altered mental
    status, hypotension, an elevated band
    formed in the differential WBC count, and
    metabolic acidosis.

    SURGICAL MANAGEMENT

    Patients with NF should be closely


    monitored during the next 24 h; surgical
    wounds and tissue viability should be
    checked.
    Complicated surgical wounds command
    a second-look operation with radical
    surgical debridement. Patients with NF
    can require from 5 up to 40 additional
    operations

    SURGICAL MANAGEMENT

    The extent of tissue extracted depends on


    the body region, which is infected.
    As a general rule, debridement will extend
    until healthy tissue is found, though some
    authors recommend that excision should be
    limited to the edges of infection .
    The general consensus is that careful
    trimming of the potentially salvageable soft
    tissue is also required (while non-infected
    skin remains unattached)

    SURGICAL MANAGEMENT

    Nutritional support is required from the


    first day of the patients admission to
    hospital (preferably the ICU), to replace
    lost proteins and fluid from large wounds
    and/or the resultant toxic shock.
    Metabolic demands are similar to those
    of other major trauma or burns, which
    means that the patient needs twice the
    basic caloric requirements.

    USE OF VACUUM-ASSISTED CLOSURE


    DEVICE

    Used for fast and effective wound closure.


    A VAC device consists of a sterile, open-cell foam
    sponge that is placed in the wound, the size of which
    is adjusted to the wound size.This is covered with a
    transparent adhesive drape to create an air- tight
    environment.
    The sponge is connected to a portablevacuum pump
    bymeans of non-collapsible tubing. Evacuation is
    applied to the sponge using the pump, which
    provides continuous negative pressure.
    TheVAC device improves wound healing by providing
    microstrain.

    USE OF VACUUM-ASSISTED CLOSURE


    DEVICE

    FUTURE THERAPIES

    A study by Anaya et al. highlighted the


    role of IVIG.
    The authors concluded that the use of
    IVIG seemed rational in patients with
    groupA streptococcal infection who
    developed streptococcal toxic shock
    syndrome and in those with a high
    mortality
    risk
    (advanced
    age,
    hypotension, and bacteremia).

    FUTURE THERAPIES

    StudybyLuetal. Showed that kallistatin,


    originally found to be a tissue kallikreinbinding protein, can increase the survival
    of group A streptococcus infected mice.
    The
    researchers
    concluded
    that
    kallistatin significantly increased the
    survival rate of GAS-infected mice, and
    also reduced local skin damage and
    bacterial counts.

    THANK YOU

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