[Infections of soft tissues by bacterial synergism]

The treatment of synergistic bacterial soft tissue infections includes usually surgical debridements and radical excisions of necrotic tissues, antibiotic therapy and volumic resuscitation. Hyperbaric oxygen therapy did not prove efficient in these plurimicrobial infections. Their severity is due to virulence synergy of aerobic and anaerobic micro organisms in the involved areas. Sixty patients were admitted in the Surgical Intensive Care Unit (december 1980-march 1989) for severe synergistic soft tissue infections. From 1980 to the end of 1983 the initial surgical treatment was extensive with wide excisions. The antibiotic therapy was selected primarily against anaerobes and gram negative rods. Since 1984 antibiotic therapy was changed to take into account all the micro-organisms found in the initial cultures, especially encountered streptococci species (43 times/60 patients). Initial surgery, after fluid resuscitation and antibiotic therapy, included debridements, colostomy in case of perineal lesion and excisions limited to the really necrotic areas. Under antibiotic therapy according to the bacteriological results, surgical management was performed daily during the first week, later when required. In these series, 14 patients died (23.3%). The mortality during the first period (1980-1983) was high: 7/2 (31.8%) and decreased to 7/38 (18.4%) in the second period (1984-1989). Cellulitis is potentially a highly lethal infection. Early recognition as well as adequate medical and surgical management may be lifesaving.