A Difficult Case of Necrotizing Fasciitis Caused By Acinetobacter baumannii
A Difficult Case of Necrotizing Fasciitis Caused By Acinetobacter baumannii
复制标题
DOI：
10.1177/1534734610389598
复制
发表时间：
2010-12-01
影响因子：
1.7
通讯作者：
Moschella, Francesco
中科院分区：
文献类型：
--
作者：
Corradino, Bartolo;Toia, Francesca;Moschella, Francesco
本研究报告的情况下，55岁的女性糖尿病与坏死性筋膜炎的右下肢和会阴，第一次承认在急诊科感染性休克与心脏骤停，后来转移到外科。微生物学和组织病理学检查证实了鲍曼不动杆菌引起的坏死性筋膜炎的诊断。给予广谱抗生素治疗，随后根据微生物培养结果重新调整。需要强化血流动力学支持。每天用3%的硼酸溶液和银磺胺嘧啶浸渍敷料包扎伤口。立即进行广泛的外科清创术，并重复进行，直到完全控制感染。伤口最后用中厚皮片覆盖。感染在入院后35天被克服。移植成功率100%。由于下肢运动功能受限，需要术后康复。6个月随访显示无功能缺陷，美学结果可接受。坏死性筋膜炎是一种危及生命的疾病，尤其是糖尿病患者，其临床诊断有时可能具有挑战性。早期识别和治疗是影响生存的最重要因素。
This study reports the case of a 55-year-old woman with diabetes with a necrotizing fasciitis of the right lower limb and the perineum, first admitted at the emergency department for septic shock with cardiac arrest, and later transferred to the department of surgery. Microbiological and histopathological examination confirmed the diagnosis of necrotizing fasciitis caused by Acinetobacter baumanii. A broad-spectrum antibiotic therapy was administered and later readjusted according to the results of microbiological culture. Intensive hemodynamic support was required. Wounds were dressed daily with a 3 percent boric acid solution and a silver sulfadiazine-impregnated dressing. An extensive surgical debridement was promptly performed and repeated until complete control of the infection. Wounds were finally covered with split-thickness skin grafts. The infection was overcome 35 days after admission. The graft take was 100%. Postoperative rehabilitation was required because of the functional limitation of lower limb movements. Follow-up at 6 months showed no functional deficit and an acceptable aesthetic result. Necrotizing fasciitis is a life-threatening disorder, especially in patients with diabetes, whose clinical diagnosis may sometimes be challenging. Early recognition and treatment represent the most important factors influencing survival.