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

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

This retrospective cohort study from 2015 to 2018 in Taiwan identified significant risk factors for mortality in patients with NSTI who underwent late amputation: presence of hemor rhagic bullae, peripheral vascular disease, bacteremia, and LRINEC score greater than 8. Level of evidence: II. 46. Stevens DL, Bryant AE, Goldstein EJ: Necrotizing soft tissue infections. Infect Dis Clin North Am 2021;35(1):135-155. This is an updated review on risk factors, microbiology, diag nosis, and management of NSTI. 47. Cortés-Penfield N, Ryder JH: Should linezolid replace clindamycin as the adjunctive antimicrobial of choice in group A streptococcal necrotizing soft tissue infection and toxic shock syndrome? A focused debate. Clin Infect Dis 2023;76(2):346-350. This is a review comparing clindamycin and linezolid as adjunctive therapy to reduce mortality in invasive group A streptococcal infection. 48. Kenneally AM, Warriner Z, VanHoose JD, et al: Evaluation of antibiotic duration after surgical debridement of nec rotizing soft tissue infection. Surg Infect (Larchmt) 2022;23(4):357-363. This retrospective study from 2010 to 2020 showed that shorter duration of antibiotic therapy after final surgical débridement of NSTI may be appropriate in patients without any other indications for antibiotic agents. Level of evidence: II. 49. Evans L, Rhodes A, Alhazzani W, et al: Surviving sepsis cam paign: International guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021;47(11):1181-1247. The International Guidelines for Management of Sepsis and Septic Shock 2021 emphasized on appropriate source control as a key principle in the management of sepsis and septic shock including débridement of infected necrotic tissue. 50. Linnér A, Darenberg J, Sjölin J, Henriques-Normark B, Norrby-Teglund A: Clinical efficacy of polyspecific intrave nous immunoglobulin therapy in patients with streptococcal toxic shock syndrome: A comparative observational study. Clin Infect Dis 2014;59(6):851-857. 51. Parks T, Wilson C, Curtis N, Norrby-Teglund A, Sriskandan S: Polyspecific intravenous immunoglobulin in clindamycin-treated patients with streptococcal toxic shock syndrome: A systematic review and meta-analysis. Clin Infect Dis 2018;67(9):1434-1436. This is a meta-analysis showing that the use of intravenous immunoglobulin in clindamycin-treated streptococcal toxic shock syndrome decreased mortality. Level of evidence: II. 52. Eskes A, Vermeulen H, Lucas C, Ubbink DT: Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds. Cochrane Database Syst Rev 2013;12:CD008059. 53. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Health Care Infection Control Practices Advisory Committee: 2007 guide line for isolation precautions: Preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35(10 suppl 2):S65-S164. 54. Bulger EM, May AK, Robinson BRH, et al: A novel immune modulator for patients with necrotizing soft tissue

infections (NSTI): Results of a multicenter, phase 3 ran domized controlled trial of reltecimod (AB 103). Ann Surg 2020;272(3):469-478. This randomized double-blind placebo-controlled trial showed that early administration of reltecimod in severe NSTI resulted in improved resolution of organ dysfunction and hospital discharge status. Level of evidence: I. 55. Moore DL, Allen UD, Mailman T: Invasive group A strepto coccal disease: Management and chemoprophylaxis. Paediatr Child Health 2019;24(2):128-129. The Canadian guidelines emphasized on the importance of penicillin in the treatment of group A streptococcal disease. 56. Chambers HF: Skin and soft tissue infections in persons who inject drugs. Infect Dis Clin North Am 2021;35(1):169-181. This review on SSTI in people who inject drugs emphasized the importance of surgical incision, drainage, and débride ment of devitalized tissue in management. 57. Maravelas R, Melgar TA, Vos D, Lima N, Sadarangani S: Pyomyositis in the United States 2002–2014. J Infect 2020;80(5):497-503. This US population–based study from 2002 to 2014 reported an increase in pyomyositis cases, with methicillin-susceptible S aureus being the most commonly identified organism. Level of evidence: II. 58. Ngor C, Hall L, Dean JA, Gilks CF: Factors associated with pyomyositis: A systematic review and meta-analysis. Trop Med Int Health 2021;26(10):1210-1219. This meta-analysis indicated a significant association between pyomyositis and HIV/AIDS. Level of evidence: II. 59. Radcliffe C, Gisriel S, Niu YS, Peaper D, Delgado S, Grant M: Pyomyositis and infectious myositis: A compre hensive, single-center retrospective study. Open Forum Infect Dis 2021;8(4):ofab098. This retrospective study from 2012 to 2020 on pyomyositis cases showed that Staphylococcus spp. accounted for 46% of all infections and that the most common symptom was muscle pain. Level of evidence: II. 60. Narayanappa G, Nandeesh BN: Infective myositis. Brain Pathol 2021;31(3):e12950. This is a review on the wide variety of pathogens causing infec tive myositis, including bacteria, fungi, viruses, and parasites. 61. Vij N, Ranade AS, Kang P, Belthur MV: Primary bacte rial pyomyositis in children: A systematic review. J Pediatr Orthop 2021;41(9):e849-e854. This systematic review on tropical pyomyositis showed that the most commonly used imaging modality was MRI and that medical management alone can be successful, but surgical treatment was often needed. Level of evidence: II. 62. Altmayer S, Verma N, Dicks EA, Oliveira A: Imaging mus culoskeletal soft tissue infections. Semin Ultrasound CT MR 2020;41(1):85-98.

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

This review on radiologic findings of soft-tissue infections showed that the widespread use of cross-sectional imag ing with MRI and CT has greatly increased the radiologic Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023


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Orthopaedic Knowledge Update ® : Musculoskeletal Infection 2

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