Back

Therapeutical problems and effective antimicrobial therapy in post-traumatic patients with Streptococcal cellulitis and Streptococcal toxic shock syndrome

Abstract number: 1135_71

Stasiak M., Lasek J., Komarnicka J., Samet A., Witkowski Z.

Objective:  

We observe an increasing number of invasive soft tissue infections caused by Streptococcus pyogenes in recent years among patients following trauma hospitalized in The Dpt. of Trauma Surgery of the Medical University of Gdañsk. GAS may cause cellulitis, necrotizing fasciitis, myositis and myonecrosis. The highest rate of mortality (30–70%) occurs in cases with Streptococcal Toxic Shock Syndrome (STSS) related with soft tissue infections in 40–50% cases.

Methods and materials:  

We analysed records of patients clinical materials from recent 2 years. We present 4 posttraumatic patients with severe GAS infections of soft tissues with cellulitis and STSS. All patients developed infectious complications following injuries. All cases required quick and aggressive surgical procedures- large incisions and removal of necrotic tissues; one of the patients needed multiple surgical interventions. Three patients improved in spite of severe course of infection; one patient died. Two patients suffered from head injury, two patients had injuries to the extremities complicated by extended tissue necrosis. Amputations of the limbs were not necessary. The course of infections was rapidly progressive with fever, extensive soft tissue necrosis and marked systemic toxicity. All cases required broad spectrum antimicrobial therapy- patients were treated with lincosamids, mainly with clindamycin given intravenously in large doses from 1800 to 3600 mg/day. In all patients microbiological procedures were performed: cultures of the wound and blood were obtained and sent for routine and anareobic cultures and for direct microscopic examination. Suitable diagnostic materials were: exsudate from the wound and fragments of necrotic tissues.

Patient Clinical diagnosisMicroorganism/ biologic material Treatment Final result
No 1 Female Age 68Suppurated head woundStreptococcus pyogenes/ wound exsudateClindamycin 3 × 600 mg Metrorndazol 3 × 100 mgDeath (13 day)
No 2 Male Age 30Abscesses of the ankle and elbow regionsStreptococcus pyogenes/ wound exsudateClindamycin 3 × 1200 mg (3 days) 3 × 900 mgRecovery
No 3 Age 52 FemaleDiffuse phlegmone of the handStreptococcus pyogenes/ wound exsudateClindamycin 3 × 600 mgRecovery
No 4 Male Age 50Suppurated head woundStreptococcus pyogenes, Staphylococcus aureus/ wounds exsudate Streptococcus pyogenes, Staphylococcus aureus/ tissue fragmentsLincomycin 3 × 600 mgRecovery

Conclusion:  

GAS infections are severe and life threatening. According to our findings clindamycin in high doses improves the prognosis and should be the drug of choice in Streptococcal cellulitis and STSS.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
Back to top