Interventions for necrotizing soft tissue infections in adults

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Surgical Infections

Background:

• Necrotizing soft tissue infections (NSTIs) are severe, rapidly spreading bacterial infections with high mortality and morbidity rates.
• Standard management includes antibiotics, surgical debridement, intensive care, and adjuvant therapies like intravenous immunoglobulin (IVIG).

Purpose of the Study:

• To assess the effects of medical and surgical treatments for adult NSTIs in hospital settings.

Main Methods:

• Searched multiple databases up to April 2018 for randomized controlled trials (RCTs) evaluating medical or surgical treatments for NSTIs.
• Included RCTs comparing different antimicrobials, adjuvant therapies (e.g., IVIG) with placebo, or surgical debridement strategies.
• Primary outcomes were 30-day mortality and serious adverse events; secondary outcomes included survival time and long-term morbidity.

Main Results:

• Included three trials with 197 participants; one compared antibiotics, two compared adjuvant therapies with placebo.
• Evidence quality was very low, leading to uncertainty about the effects of moxifloxacin vs. amoxicillin-clavulanate and AB103 vs. placebo on mortality and adverse events.
• Low-certainty evidence suggested no clear difference between IVIG and placebo for mortality or serious adverse events.

Conclusions:

• Very limited evidence exists for NSTI treatments, precluding conclusions on 30-day mortality or serious adverse events due to very low evidence quality.
• Small sample sizes and risk of bias impact the reliability of findings.
• Future research should focus on clearly defined criteria, potentially using observational studies and prospective registries to assess empiric antimicrobial therapy, surgical debridement, and adjuvant therapies, with key outcomes being acute mortality and long-term functional outcomes.