摘要
背景:重症坏死性软组织感染(NSTI)临床罕见,临床医师对其认识不足。目的:总结NSTI的临床特点、致病微生物及预后,为该病的临床诊治提供参考。方法:回顾性分析2015年1月至2020年1月收治的NSTI患者13例。记录患者基本信息、入院实验室检查结果、病原学数据、临床结果、NSTI预测评分[坏死性筋膜炎实验室风险指标(LRINEC)评分、SIARI评分、NAS评分]、患者危重程度评分[APACHEⅡ评分、序贯器官衰竭估计(SOFA)评分]。结果:本组13例确诊为NSTI的患者死亡2例(15.4%)。感染部位:下肢9例(69.2%),上肢、骶尾部、会阴区和腹部各1例。LRINEC评分、SIARI评分和NAS评分预测NSTI的假阴性率分别为7.7%(1/13)、38.5%(5/13)和23.1%(3/13)。7例患者(53.8%)伤口分泌物粗大杆菌涂片阳性。Ⅰ型(混合微生物感染)6例(46.15%),Ⅱ型(单一微生物感染)6例(46.15%),无培养结果1例(7.7%)。2例死亡患者均为化脓性链球菌感染。Ⅰ型与Ⅱ型NSTI患者实验室检查结果差异均无统计学意义(P均>0.05)。从入院到初次手术的时间为9(4-15)h,重症监护治疗病房(ICU)住院时间为15(4-48)d,总住院时间为36(8-74)d。结论:早期诊断和治疗是改善NSTI患者预后最重要的手段。产气荚膜梭菌和化脓性链球菌感染是导致NSTI患者死亡的主要致病菌。目前LRINEC评分可能仍是对NSTI较有价值的筛查工具。
Background:Severe necrotizing soft tissue infection(NSTI)is poorly recognized in clinical practice due to its rarity.Objective:To summarize clinical characteristics,pathogenic microorganisms and prognosis of NSTI.Methods:A retrospective study was conducted.Clinical data of 13 NSTI patients who had been admitted to Beijing Jishuitan Hospital between January 2015 and January 2020 were collected,including demographic data,initial laboratory tests,pathogenic results,prognosis and disease severity scores(APACHEⅡ,sequential organ failure assessment[SOFA]).The efficacy of NSTI predictive scores(Laboratory Risk Indicator for Necrotizing Fasciitis[LRINEC]score,SIARI score,NAS score)were validated by this case series.Results:Two patients(15.4%)of the case series died.The infection sites were lower extremity(n=9,69.2%),upper extremity(n=1),sacrococcygeal area(n=1),perineum area(n=1),and abdomen(n=1).The false negative ratio of LRINEC score,SIARI score and NAS score were 7.7%(1/13),38.5%(5/13)and 23.1%(3/13),respectively.Seven cases had a positive smear result of Gram-positive crude bacillus.The culture result revealed 6 cases(46.2%)of typeⅠinfection and 6cases(46.2%)of typeⅡinfection.No bacterium was cultivated in 1 patient(7.7%).The two deaths were both due to Streptococcus pyogenes infection.No significant laboratory difference was detected between typeⅠand typeⅡinfection(P>0.05).The medium time from admission to the first operation was 9 h(4 h,15 h).The medium ICU stay was 15 d(4 d,48 d).The medium hospital stay was 36 d(8 d,74 d).Conclusions:Early diagnosis and prompt treatment are crucial for the prognosis of NSTI.Clostridium perfringens and Streptococcus pyogenes are main lethal pathogens of NSTI.LRINEC score may still be a proper predictive tool for NSTI.
作者
崔真
孙旭
田彭
刘颖
毛璐
白颖
CUI Zhen;SUN Xu;TIAN Peng;LIU Ying;MAO Lu;BAI Ying(Department of Critical Care Medicine,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Orthopaedic Trauma,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Burns and Plastic Surgery,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Clinical Laboratory,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Pharmacy,Beijing Jishuitan Hospital,Beijing 100035,China)
出处
《中华骨与关节外科杂志》
2021年第7期621-625,637,共6页
Chinese Journal of Bone and Joint Surgery
