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.
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 (3070%) occurs in cases with Streptococcal Toxic Shock Syndrome (STSS) related with soft tissue infections in 4050% 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.
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 name:||XXIst ISTH Congress|
|Back to top|