Improving outcomes for patients with necrotizing soft tissue infections

Abstract

Necrotizing soft tissue infections (NSTIs) are lethal and rare infections of the soft tissues, which are especially notorious for their rapid spreading nature and sometimes mutilating surgeries, consisting of resecting all infected tissue and in some cases amputation of a limb, necessary to prevent further spreading of the infection.

This thesis describes almost all facets of NSTIs: from its current incidence and mortality rate in the Netherlands, to the recommendation and validation of triple diagnostics (a combination of macroscopic evaluation of the tissue by the surgeon and in case of doubt additional microscopic diagnostics testing by microbiologists and pathologists, all done during the same surgery) to improve the diagnostic process of NSTIs, to the confirmation that NSTIs are indeed time sensitive infections, to which (patient, disease and treatment) characteristics predict mortality, necessity for amputation, quality of life and the long-term satisfaction with appearance. Within this thesis the essential cornerstones of the NSTI treatment, consisting of early recognition, rapid diagnosis without unnecessary delays, immediate administration of intravenous broad-spectrum antibiotics, surgical debridement of all infected and necrotic tissue, and resuscitation in case of a septic patient, are both demonstrated and supported with current literature. These cornerstones combined and optimized lead tot lower mortality rates and shorter hospital and intensive care stays, which increased the chances of these patients to have a decent to good quality of life with good cognitive and functional outcomes, which then makes way for future research to focus more on the optimization of (objective and subjective) esthetic outcomes.