Hyperbaric oxygen does not improve outcome in patients with necrotizing soft tissue infection.


BACKGROUND:Patients with necrotizing soft tissue infections (NSTIs) require prompt surgical debridement, appropriate intravenous antibiotics, and intensive support. Despite aggressive treatment, their mortality and morbidity rates remain high. The benefit of hyperbaric oxygen (HBO) as an adjunctive treatment is controversial. We investigated the effect of HBO in treating NSTIs. METHODS:We analyzed clinical data retrospectively for 78 patients with NSTIs: 30 patients at one center were treated with surgery, antibiotics, and supportive care; 48 patients at a different center received adjunctive HBO treatment. We compared the two groups in terms of demographic characteristics, risk factors, NSTI microbiology, and patient outcomes. To identify variables associated with higher mortality rates, we used logistic regression analysis. RESULTS:Demographic characteristics and risk factors were similar in the HBO and non-HBO groups. The mean patient age was 49.5 years; 37% of the patients were female, and 49% had diabetes mellitus. Patients underwent a mean of 3.0 excisional debridements. The median hospital length of stay was 16.5 days; the median duration of antibiotic use was 15.0 days. In 36% of patients, cultures were polymicrobial; group A Streptococcus was the organism most commonly isolated (28%). We identified no statistically significant differences in outcomes between the two groups. The mortality rate for the HBO group (8.3%) was lower, although not significantly different (p = 0.48), than that observed for the non-HBO group (13.3%). The number of debridements was greater in the HBO group (3.0; p = 0.03). The hospital length of stay and duration of antibiotic use were similar for the two groups. Multivariable analysis showed that hypotension on admission and immunosuppression were significant independent risk factors for death. CONCLUSIONS:Adjunctive use of HBO to treat NSTIs did not reduce the mortality rate, number of debridements, hospital length of stay, or duration of antibiotic use. Immunosupression and early hypotension were important risk factors associated with higher mortality rates in patients with NSTIs.


Surg Infect (Larchmt)


Surgical infections


George ME,Rueth NM,Skarda DE,Chipman JG,Quickel RR,Beilman GJ




Has Abstract


2009-02-01 00:00:00












  • Severe group a streptococcus infection after thyroidectomy: report of three cases and review.

    abstract:BACKGROUND:Group A Streptococcus (GAS) is an uncommon cause of infection after clean surgery in non-pregnant adults. METHODS:Report of three cases and review of the literature. results: For the first time in France, severe GAS infections were observed in three patients who underwent thyroidectomy at three hospitals. T...

    journal_title:Surgical infections

    pub_type: 杂志文章,评审


    authors: Faibis F,Sapir D,Luis D,Laigneau P,Lepoutre A,Pospisil F,Borgey F,Demachy MC,Botterel F

    更新日期:2008-10-01 00:00:00

  • A prospective evaluation of the use of emergency department computed tomography for suspected acute appendicitis.

    abstract:BACKGROUND:Computed tomography (CT) is used increasingly to evaluate suspected cases of acute appendicitis (AA) in the emergency department (ED). This prospective study was performed to test the hypothesis that the evaluation of AA by CT in the ED remains suboptimal and that erroneous interpretation diminishes its util...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Maluccio MA,Covey AM,Weyant MJ,Eachempati SR,Hydo LJ,Barie PS

    更新日期:2001-10-01 00:00:00

  • Successful treatment of Scedosporium aurantiacum osteomyelitis in an immunocompetent patient.

    abstract:BACKGROUND:Bacterial infections are a well-known complication of traumatic amputations. In cases involving contact with soil or water contaminated with manure, one also must be aware of infections with fungi, particularly Scedosporium spp. We report on an immunocompetent trauma patient with an infection caused by a rec...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Kooijman CM,Kampinga GA,de Hoog GS,Goudswaard WB,Reijnen MM

    更新日期:2007-12-01 00:00:00

  • Combined Strategy for Post-Operative Patients with Central Nervous System Infections Caused by Extensively Drug-Resistant/Pan-Drug-Resistant Acinetobacter baumannii: A Retrospective Study.

    abstract:: Background: Post-operative central nervous system infections (PCNSIs) caused by extensively drug-resistant (XDR) or pan-drug-resistant (PDR) Acinetobacter baumannii are rare but intractable problems. To investigate a potential combined strategy to treat Acinetobacter bauma...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Chang JB,Chen Y,Wang H,Ma X,Zhang X,Wu H,Ma B,Zuo W,Ma W,Wang R,Wei J

    更新日期:2020-12-01 00:00:00

  • Adrenergic modulation of erythropoiesis following severe injury is mediated through bone marrow stroma.

    abstract:BACKGROUND:Severe trauma leads to hematopoietic failure and bone marrow (BM) dysfunction that manifests clinically as a persistent anemia and leukopenia. The impact of severe trauma and its associated hyperadrenergic state on erythropoiesis has not been described. The aim of this study was to demonstrate the effects of...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Fonseca RB,Mohr AM,Wang L,Clinton E,Sifri ZC,Rameshwar P,Livingston DH

    更新日期:2004-01-01 00:00:00

  • Safety of excisional inguinal lymph node biopsies performed for research purposes in HIV-1-infected women and men.

    abstract:BACKGROUND:Most HIV-1 replication occurs in secondary lymphoid tissues, and evaluating these tissues is crucial to investigations of pathogenesis. Inguinal lymph nodes (LN) are obtained frequently for these studies as they are readily detectable in most individuals and provide abundant numbers of cells. Knowledge of th...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Meditz AL,Connick E,McCarter M

    更新日期:2014-08-01 00:00:00

  • Clostridium perfringens surgical site infection after osteotomy for knee deformity correction in a non-immunocompromised child.

    abstract:BACKGROUND:Clostridium perfringens myonecrosis following an elective surgical procedure in a previously healthy child is a rare incident. METHODS:Case report and literature review. RESULTS:A two-year old boy admitted for elective bilateral osteotomies of tibiae was detected to be febrile at day one post-operatively w...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Abd Rashid AH,Ramli R,Ibrahim S

    更新日期:2014-10-01 00:00:00

  • Treatment of severe sepsis secondary to mycobacterium avium-intracellulare with recombinant human activated protein C.

    abstract:BACKGROUND:Mycobacterium avium-intracellulare (MAI) is a well-described pathogen in patients with acquired immune deficiency syndrome (AIDS). However, peritonitis and severe sepsis as a complication of disseminated MAI is rare. We report a case that represents the first successful use of recombinant human activated pro...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Ullery B,Pieracci FM,Hydo LJ,Eachempati SR,Barie PS

    更新日期:2008-06-01 00:00:00

  • Endotracheal intubation: the role of sterility.

    abstract:BACKGROUND:There is a paucity of data regarding whether sterile handling of endotracheal tubes (ETTs) impacts the incidence and prevalence of pneumonia in the emergency, urgent, or elective clinical scenarios. Intensive care units employ infection control and reduction schemes to reduce pneumonia rates. METHODS:A MEDL...

    journal_title:Surgical infections

    pub_type: 杂志文章,评审


    authors: Cheung N,Betro G,Luckianow G,Napolitano L,Kaplan LJ

    更新日期:2007-10-01 00:00:00

  • Purpura fulminans managed with multi-limb amputation: substituted judgment and surrogate decision-making in the surgical management of necrotizing soft tissue infections.

    abstract:BACKGROUND:Purpura fulminans (PF) is a rare but lethal complication of severe infection. Aggressive surgical debridement of irreversibly devitalized tissue improves survival frequently at the cost of disfigurement. The ethical dilemma of surrogate decision-making for these often incapacitated patients presents a unique...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Tanosaki M,Shimizu N,Lian CG,Jurchak M,Patel V

    更新日期:2014-12-01 00:00:00

  • Donor risk index predicts graft failure reliably but not post-transplant infections.

    abstract:BACKGROUND:The Donor Risk Index (DRI) is used to predict graft survival following liver transplantation, but has not been used to predict post-operative infections in graft recipients. We hypothesized that lower-quality grafts would result in more frequent infectious complications. METHODS:Using a prospectively collec...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Rosenberger LH,Gillen JR,Hranjec T,Stokes JB,Brayman KL,Kumer SC,Schmitt TM,Sawyer RG

    更新日期:2014-04-01 00:00:00

  • Surgical infections with enterococcus: outcome in patients treated with ertapenem versus piperacillin-tazobactam.

    abstract:BACKGROUND:The pathogenicity of Enterococcus in polymicrobial surgical infections is controversial. The objective of this analysis was two-fold. The impact of Enterococcus on clinical outcome was assessed in adults with complicated intra-abdominal (IAI), complicated skin and skin structure (CSSSI), or acute pelvic (PI)...

    journal_title:Surgical infections

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


    authors: Teppler H,McCarroll K,Gesser RM,Woods GL

    更新日期:2002-01-01 00:00:00

  • Pathogenesis of multiple organ dysfunction syndrome--endotoxin, inflammatory cells, and their mediators: cytokines and reactive oxygen species.

    abstract::Multiple organ dysfunction syndrome (MODS) is caused by an overwhelming, uncontrolled systemic inflammatory response that is activated by a number of hostile stimuli including sepsis, hypovolemic shock, and severe trauma resulting in massive tissue injury. The indiscriminate activation of the inflammatory response due...

    journal_title:Surgical infections

    pub_type: 杂志文章,评审


    authors: Maier RV

    更新日期:2000-10-01 00:00:00

  • Daptomycin-associated eosinophilic pneumonia in two patients with prosthetic joint infection.

    abstract:BACKGROUND:Daptomycin is used increasingly to treat prosthetic joint infection (PJI). A possible side effect of this drug is eosinophilic pneumonia. We describe two patients with PJI treated with daptomycin who had this side effect with different clinical presentations. METHODS:Case reports and review of the literatur...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Yusuf E,Perrottet N,Orasch C,Borens O,Trampuz A

    更新日期:2014-12-01 00:00:00

  • Use of an antimicrobial skin sealant reduces surgical site infection in patients undergoing routine cardiac surgery.

    abstract:BACKGROUND:With high morbidity and potentially devastating consequences, surgical site infections (SSIs) after cardiac surgery add substantially to the healthcare burden. Inhibiting migration of skin microbes is likely to reduce contamination of the surgical incision by endogenous potential pathogens. We studied the ef...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Dohmen PM,Weymann A,Holinski S,Linneweber J,Geyer T,Konertz W

    更新日期:2011-12-01 00:00:00

  • Mediator responses in surgical infections.

    abstract:BACKGROUND:Surgical infections, and sepsis in particular, are characterized by extensive release of mediators. Our laboratories have been interested in understanding how these substances contribute to morbidity and mortality during various stages of surgical infections in order to develop new and more effective therape...

    journal_title:Surgical infections

    pub_type: 杂志文章,评审


    authors: Aasen AO,Wang JE

    更新日期:2006-01-01 00:00:00

  • Vancomycin versus linezolid in the treatment of methicillin-resistant Staphylococcus aureus meningitis.

    abstract:BACKGROUND:Vancomycin is the mainstay of treatment for methicillin-resistant Staphylococcus aureus (MRSA) meningitis. However, successful outcomes with linezolid have not been reported in a large series of patients. We conducted a single-center retrospective cohort study to compare vancomycin with linezolid in the trea...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Sipahi OR,Bardak-Ozcem S,Turhan T,Arda B,Ruksen M,Pullukcu H,Aydemir S,Dalbasti T,Yurtseven T,Sipahi H,Zileli M,Ulusoy S

    更新日期:2013-08-01 00:00:00

  • Antimicrobial Activity of Ceftaroline Tested against Staphylococcus aureus from Surgical Skin and Skin Structure Infections in US Medical Centers.

    abstract:BACKGROUND:Ceftaroline fosamil is a novel cephalosporin approved by the United States Food and Drug Administration (US FDA) for treatment of acute bacterial skin and skin structure infection, including those caused by methicillin-resistant Staphylococcus aureus (MRSA). We evaluated the activity of ceftaroline and compa...

    journal_title:Surgical infections

    pub_type: 杂志文章,多中心研究


    authors: Sader HS,Farrell DJ,Flamm RK,Jones RN

    更新日期:2016-08-01 00:00:00

  • Right Colectomy and Abdominal Perineal Resection for Cancer: Do Urinary Tract Infections Impact Outcomes?

    abstract:BACKGROUND:We aim to assess the patient factors and concomitant infectious outcomes associated with urinary tract infection (UTI) occurrence and the impact of UTI on length of stay (LOS), re-admission, and death in a colorectal surgical population. PATIENTS AND METHODS:National Surgical Quality Improvement Program Use...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Armstrong JG,Li CH,Liao J,Byrn JC

    更新日期:2017-07-01 00:00:00

  • Enterobius vermicularis infection with tuboovarian abscess and peritonitis occurring during pregnancy.

    abstract:BACKGROUND:Extraintestinal Enterobius vermicularis infections are rare but may occasionally affect the female genital tract. Although mostly asymptomatic or causing minor clinical problems, they may lead to severe infectious complications. METHODS:Case report and review of the pertinent English language literature. R...

    journal_title:Surgical infections

    pub_type: 杂志文章,评审


    authors: Craggs B,De Waele E,De Vogelaere K,Wybo I,Laubach M,Hoorens A,De Waele B

    更新日期:2009-12-01 00:00:00

  • New antibiotic agents: problems and prospects.

    abstract:BACKGROUND:Surgical site infections are the third most common healthcare-associated infection, often leading to prolonged hospital stay and excessive expenditures. Management of these infections has become more challenging due to rising rates of multi-drug-resistant organisms and few new antibiotic options. METHODS:Th...

    journal_title:Surgical infections

    pub_type: 杂志文章,评审


    authors: Weber DJ,Rutala WA

    更新日期:2005-01-01 00:00:00

  • Relation between Sarcopenia and Surgical Site Infection in Patients Undergoing Gastric Cancer Surgery.

    abstract:: Background: Sarcopenia is a syndrome that can have negative consequences after gastric cancer (GC) surgery. This study aims to determine the effect of sarcopenia on surgical site infection (SSI) that develops after open GC surgery. Patients and Met...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Olmez T,Gulmez S,Karakose E,Ofluoglu CB,Senger AS,Bozkurt H,Duman M,Polat E

    更新日期:2020-11-11 00:00:00

  • Trends in postoperative sepsis: are we improving outcomes?

    abstract:BACKGROUND AND PURPOSE:Each year, as many as two million operations are complicated by surgical site infections in the United States, and surgical patients account for 30% of patients with sepsis. The purpose of this study was to determine recent trends in sepsis incidence, severity, and mortality rate after surgical p...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Vogel TR,Dombrovskiy VY,Lowry SF

    更新日期:2009-02-01 00:00:00

  • Colorectal anastomotic leakage caused by insufficient suturing after partial colectomy: a new experimental model.

    abstract:BACKGROUND:Colorectal anastomotic leakage (CAL) is the most important complication of colorectal surgery, accounting for one third of post-operative deaths. To prevent it, many interventions have been tested in animal models, mostly rats. However, few of these models have been validated. We aimed to develop a reproduci...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Wu Z,Daams F,Boersema GS,Vakalopoulos KA,Lam KH,van der Horst PH,Kleinrensink GJ,Jeekel J,Lange JF

    更新日期:2014-12-01 00:00:00

  • Neonatal osteomyelitis and complex nephro-ureteral duplication.

    abstract:OBJECTIVE:This report presents a case of femoral osteomyelitis secondary to urinary tract infection in a female neonate with bilateral urinary duplication and right ectopic ureterocele. METHODS:A female neonate with a history of late perinatal sepsis presented to the emergency department and was found to have left dis...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: de Jesus LE,Fernandes A,Sias SM,de Mello CM,de Carvalho AM,Junior NC

    更新日期:2011-02-01 00:00:00

  • Outcomes of operative management of appendicitis.

    abstract:BACKGROUND:There has not been an appraisal of outcomes of appendectomy for more than 10 years. More reliable diagnostic techniques and minimally invasive surgery are now in widespread use, yet the impact of these advances remains unknown. METHODS:A retrospective review was performed of 453 patients who underwent appen...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Dhupar R,Evankovich J,Ochoa JB,Vargas LG,Hughes SJ

    更新日期:2012-06-01 00:00:00

  • Pre-hospital intubation factors and pneumonia in trauma patients.

    abstract:BACKGROUND:We reported similar rates of ventilator-associated pneumonia (VAP) previously in trauma patients intubated either in a pre-hospital (PH) venue or the emergency department. A subset of PH intubations with continuous quality assessment was re-examined to identify the intubation factors associated with VAP. ME...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Evans HL,Warner K,Bulger EM,Sharar SR,Maier RV,Cuschieri J

    更新日期:2011-10-01 00:00:00

  • Resolution of clinical and laboratory abnormalities after diagnosis of ventilator-associated pneumonia in trauma patients.

    abstract:BACKGROUND:Guidelines advise that patients with ventilator-associated pneumonia (VAP) should respond clinically by Day 3 of antibiotics. White blood cell (WBC) count, maximum temperature (Tmax), and PaO2:FIO2 ratio are all said to respond significantly by Day 6. Resolution of abnormalities has not been evaluated in tra...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Swanson JM,Connor KA,Magnotti LJ,Croce MA,Johnson J,Wood GC,Fabian TC

    更新日期:2013-02-01 00:00:00

  • Awareness of Practice and Comparison with Best Evidence in Surgical Site Infection Prevention in Colorectal Surgery.

    abstract:: Background: The use of mechanical bowel preparation and prophylaxis with oral antimicrobial agents can prevent surgical site infection (SSI) in colorectal surgical procedures, but routine adoption of these and other practices by surgeons has been limited. The aim of this s...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Badia JM,Casey AL,Rubio-Pérez I,Arroyo-García N,Espin E,Biondo S,Balibrea JM

    更新日期:2020-04-01 00:00:00

  • Nucleated red blood cells are associated with a higher mortality rate in patients with surgical sepsis.

    abstract:BACKGROUND:Nucleated red blood cells (NRBCs) are present in certain non-oncologic disease states and are associated with a poor prognosis. The purpose of this study was to evaluate NRBCs as an early prognostic marker for death in patients with surgical sepsis. METHODS:Retrospective evaluation of data collected prospec...

    journal_title:Surgical infections

    pub_type: 杂志文章


    authors: Desai S,Jones SL,Turner KL,Hall J,Moore LJ

    更新日期:2012-12-01 00:00:00