Orthopaedic Knowledge Update®: Musculoskeletal Infection 2 Print + Ebook (AAOS - American Academy of Orthopaedic Surgeons)

Section 6: Bone, Joint, and Soft-Tissue Infections

Six cases in a forensic pathology practice where necrotizing fasciitis posed a unique medicolegal dilemma were examined in this article. Level of evidence: IV. 21. Kim MJ, Shin SH, Park JY: Medicolegal implications from litigations involving necrotizing fasciitis. Ann Surg Treat Res 2020;99(3):131-137. The outcome of 25 cases of medical malpractice litigation involving necrotizing fasciitis from 1998 to 2018 showed that physicians cannot be blamed for the failure to prevent necrotizing fasciitis. Level of evidence: IV. 22. Beaudoin AL, Torso L, Richards K, et al: Invasive group A Streptococcus infections associated with liposuction surgery at outpatient facilities not subject to state or federal regula tion. JAMA Intern Med 2014;174(7):1136-1142. 23. Zhang JX, McSweeney CT, Bush KL: Nosocomial transmis sion of necrotising fasciitis organisms from prepartum patient to healthcare worker. BMJ Case Rep 2021;14(5):e240848. This is a case report of nosocomial transmission of necrotiz ing fasciitis from a prepartum patient to a health care worker. Level of evidence: IV. 24. Garcia NM, Cai J: Aggressive soft tissue infections. Surg Clin North Am 2018;98(5):1097-1108. This is a review on NSTI presentation, diagnosis, mortality, and surgical and antimicrobial treatment. 25. Geng C, Yu K, Li F: Necrotizing fasciitis caused by mucormy cosis: A case report and literature review. Int J Low Extrem Wounds 2022; February 15 [Epub ahead of print]. This is a case report of necrotizing fasciitis of the limb caused by mucormycosis managed with antifungal treatment and repeated débridement. Level of evidence: IV. 26. Horn DL, Roberts EA, Shen J, et al: Outcomes of β -hemo lytic streptococcal necrotizing skin and soft-tissue infections and the impact of clindamycin resistance. Clin Infect Dis 2021;73(11):e4592-e4598. This retrospective study from 2015 and 2018 showed a high prevalence of beta-hemolytic streptococci (more specifically clindamycin resistant) in NSTI and a greater risk of ampu tation with this pathogen. Level of evidence: II. 27. Khanna A, Taylor MD: Necrotising myositis – Learnings for a plastic surgeon. J Plast Reconstr Aesthet Surg 2022;75(1):145-151. This is a systematic review on necrotizing myositis case reports showing that three-fourth of these cases were a result of group A Streptococcus infections. 28. Martin SJ, Stephen VS: Pitfalls in medicine: Pain out of pro portion to examination findings. Br J Hosp Med (Lond) 2022;83(4):1-8. There is a raising awareness that NSTI can present with pain out of proportion to physical examination.

13. Martin H, Bursztejn AC, Albuisson E, et al: Characteristics of chronic wounds in substance abuse: A retrospective study of 58 patients [Article in French]. Ann Dermatol Venereol 2019;146(12):793-800. Drug abuse–related chronic wounds were more likely to occur in young men with a history of injection drug abuse. Level of evidence: II. 14. Collins CM, McCarty A, Jalilvand A, et al: Outcomes of patients with necrotizing soft tissue infections: A propensi ty-matched analysis using the national inpatient sample. Surg Infect (Larchmt) 2022;23(3):304-312. This retrospective study from 2012 to 2018 identified older age and having two or more comorbidities as risk factors associated with mortality in NSTI. Level of evidence: II. 15. Al-Qurayshi Z, Nichols RL, Killackey MT, Kandil E: Mortality risk in necrotizing fasciitis: National prevalence, trend, and burden. Surg Infect (Larchmt) 2020;21(10):840-852. This retrospective cross-sectional study from 2010 to 2014 showed that NSTI with septicemia and lack of surgical interven tion were associated with higher mortality. Level of evidence: II. 16. Naamany E, Shiber S, Duskin-Bitan H, et al: Polymicrobial and monomicrobial necrotizing soft tissue infections: Comparison of clinical, laboratory, radiological, and patho logical hallmarks and prognosis. A retrospective analysis. Trauma Surg Acute Care Open 2021;6(1):e000745. This retrospective study from 2002 to 2019 showed that patients with monomicrobial NSTI had a significantly higher 90-day mortality rate in addition to higher rates of in-hospital mortality, intensive care unit admission, and vasopressor use than those with polymicrobial NSTI. Level of evidence: II. 17. Karnuta J, Featherall J, Lawrenz J, et al: What demographic and clinical factors are associated with in-hospital mortality in patients with necrotizing fasciitis? Clin Orthop Relat Res 2020;478(8):1770-1779. A retrospective study during a 10-year period identified risk factors associated with in-hospital mortality in necrotizing fasciitis, including older age, coronary artery disease, chronic kidney disease, and transfer from an outside hospital. Level of evidence: II. 18. Bakleh M, Wold LE, Mandrekar JN, Harmsen WS, Dimashkieh HH, Baddour LM: Correlation of histopatho logic findings with clinical outcome in necrotizing fasciitis. Clin Infect Dis 2005;40(3):410-414. 19. Nguyen QD, Diab J, Khaicy D, et al: The impact of COVID 19 on delayed presentations of necrotising fasciitis. J Surg Case Rep 2022;2022(2):rjac015. This retrospective study from 2017 to 2020 showed that COVID-19 patients with necrotizing fasciitis had longer mean onset of symptoms until hospital presentation and were more likely to be admitted to the intensive care unit compared with non–COVID-19 patients with necrotizing fasciitis. Level of evidence: II. 20. Abder-Rahman H, Habash I, Alami R, Alnimer T, Al-Abdallat I: Medico-legal importance of necrotizing fas ciitis. J Forensic Leg Med 2020;74:102019.

Section 6: Bone, Joint, and Soft-Tissue Infections

29. Gunaratne DA, Tseros EA, Hasan Z, et al: Cervical necrotiz ing fasciitis: Systematic review and analysis of 1235 reported cases from the literature. Head Neck 2018;40(9):2094-2102. This systematic review of case reports on cervical necrotiz ing fasciitis showed that most had odontogenic origin and required numerous débridement. Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023

302

© 2025 American Academy of Orthopaedic Surgeons

Orthopaedic Knowledge Update ® : Musculoskeletal Infection 2