Microbiological Etiology of Necrotizing Soft Tissue Infections

  • Chapter
  • First Online:
Necrotizing Soft Tissue Infections

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 1294))

Abstract

Necrotizing soft tissue infections (NSTIs) are severe clinical conditions requiring swift therapeutic intervention, including surgical removal of infected tissue and administration of potent antibiotics. There is wide diversity in the microbial etiologic agents, and tailoring the antibiotic treatment to the offending pathogen is essential. However, the choice of empirical therapy is frequently inadequate, underlining the need for comprehensive and contemporary knowledge on causative pathogens and relevant antimicrobial resistance patterns in NSTIs. Also, studies of the pathogenic mechanisms in different NSTIs are needed, to improve handling of patients through develo** patient stratification and tailored therapies. We review the current knowledge on microbial etiology and provide detailed characterizations of the predominant pathogens.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (Canada)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (Canada)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (Canada)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (Canada)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Anaya DA, Dellinger EP (2007) Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis 44:705–710

    Article  CAS  PubMed  Google Scholar 

  • Anaya DA, McMahon K, Nathens AB, Sullivan SR, Foy H, Bulger E (2005) Predictors of mortality and limb loss in necrotizing soft tissue infections. Arch Surg 140:151–157

    Article  PubMed  Google Scholar 

  • Barker FG, Leppard BJ, Seal DV (1987) Streptococcal necrotising fasciitis: comparison between histological and clinical features. J Clin Pathol 40:335–341

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Baude J, Bastien S, Gillet Y, Leblanc P, Itzek A, Tristan A, Bes M, Duguz S, Moreau K, Diep BA, Norrby-Teglund A, Henry T, Vandenesch F, INFECT Study Group (2019) Necrotizing soft tissue infection Staphylococcus aureus but not S. pyogenes isolates display high rates of internalization and cytotoxicity toward human myoblasts. J Infect Dis 220:710–719

    Article  CAS  PubMed  Google Scholar 

  • Bier N, Schwartz K, Guerra B, Strauch E (2015) Survey on antimicrobial resistance patterns in Vibrio vulnificus and Vibrio cholerae non-O1/non-O139 in Germany reveals carbapenemase-producing Vibrio cholerae in coastal waters. Front Microbiol 6:1179

    Article  PubMed  PubMed Central  Google Scholar 

  • Bjurlin MA, O’Grady T, Kim DY, Divakaruni N, Drago A, Blumetti J, Hollowell CM (2013) Causative pathogens, antibiotic sensitivity, resistance patterns, and severity in a contemporary series of Fournier's gangrene. Urology 81:752–758

    Article  PubMed  Google Scholar 

  • Boyer A, Vargas F, Coste F, Saubusse E, Castaing Y, Gbikpi-Benissan G, Hilbert G, Gruson D (2009) Influence of surgical treatment timing on mortality from necrotizing soft tissue infections requiring intensive care management. Intensive Care Med 35:847–853

    Article  PubMed  Google Scholar 

  • Brook I (2012) Anaerobic bacteria in upper respiratory tract and head and neck infections: microbiology and treatment. Anaerobe 18:214–220

    Article  PubMed  Google Scholar 

  • Brook I, Frazier EH (1995) Clinical and microbiological features of necrotizing fasciitis. J Clin Microbiol 33:2382–2387

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bruun T, Kittang BR, De Hoog BR, Aardal S, Flaatten HK, Langeland N, Mylvaganam H, Vindenes HA, Skrede S (2013) Necrotizing soft tissue infections caused by Streptococcus pyogenes and Streptococcus dysgalactiae subsp. equisimilis of groups C and G in western Norway. Clin Microbiol Infect 19:E545–E550

    Article  CAS  PubMed  Google Scholar 

  • Bruun T, Rath E, Madsen MB, Oppegaard O, Nekludov M, Arnell P, Karlsson Y, Babbar A, Bergey F, Itzek A, Hyldegaard O, Norrby-Teglund A, Skrede S, Infect Study Group (2020) Risk factors and predictors of mortality in streptococcal necrotizing soft-tissue infections: a Multicenter prospective study. Clin Infect Dis. https://doi.org/10.1093/cid/ciaa027

  • Calandra T, Cohen J, International Sepsis Forum Definition of Infection in the ICU Consensus Conference (2005) The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med 33:1538–1548

    Article  PubMed  Google Scholar 

  • Chao W-N, Tsai C-F, Chang H-R, Chan K-S, Su C-H, Lee Y-T, Ueng K-C, Chen C-C, Chen S-C, Lee M-C (2013) Impact of timing of surgery on outcome of Vibrio vulnificus-related necrotizing fasciitis. Am J Surg 206:32–39

    Article  PubMed  Google Scholar 

  • Chelsom J, Halstensen A, Haga T, Høiby EA (1994) Necrotising fasciitis due to group A streptococci in western Norway: incidence and clinical features. Lancet 344:1111–1115

    Article  CAS  PubMed  Google Scholar 

  • Chia L, Crum-Cianflone NF (2018) Emergence of multi-drug resistant organisms (MDROs) causing Fournier’s gangrene. J Infect 76:38–43

    Article  PubMed  Google Scholar 

  • Childers BJ, Potyondy LD, Nachreiner R, Rogers FR, Childers ER, Oberg KC, Hendricks DL, Hardesty RA (2002) Necrotizing fasciitis: a fourteen-year retrospective study of 163 consecutive patients. Am Surg 68:109–116

    PubMed  Google Scholar 

  • Choi HK, Seo GH, Han E (2020) The incidence and seasonal variation of necrotizing fasciitis in Korea: a nationwide cross-sectional study. Clin Microbiol Infect pii:S1198-743X(20)30003-3

    Google Scholar 

  • Chuang PY, Yang TY, Huang TW, Tsai YH, Huang KC, Weng HH (2019) Hepatic disease and the risk of mortality of Vibrio vulnificus necrotizing skin and soft tissue infections: a systematic review and meta-analysis. PLoS One 25:e0223513

    Article  CAS  Google Scholar 

  • Commons RJ, Smeesters PR, Proft T, Fraser JD, Robins-Browne R, Curtis N (2014) Streptococcal superantigens: categorization and clinical associations. Trends Mol Med 20:48–62

    Article  CAS  PubMed  Google Scholar 

  • Cummings LA, Hoogestraat DR, Rassoulian-Barrett SL, Rosenthal CA, Salipante SJ, Cookson BT, Hoffman NG (2020) Comprehensive evaluation of complex polymicrobial specimens using next generation sequencing and standard microbiological culture. Sci Rep 10:5446

    Article  PubMed  PubMed Central  Google Scholar 

  • Czymek R, Kujath P, Bruch HP, Pfeiffer D, Nebrig M, Seehofer D, Guckelberger O (2013) Treatment, outcome and quality of life after Fournier’s gangrene: a multicentre study. Color Dis 15:1529–1536

    Article  CAS  Google Scholar 

  • Das DK, Baker MG, Venugopal K (2012) Risk factors, microbiological findings and outcomes of necrotizing fasciitis in New Zealand: a retrospective chart review. BMC Infect Dis 12:348

    Article  PubMed  PubMed Central  Google Scholar 

  • Elliott D, Kufera JA, Myers RA (2000) The microbiology of necrotizing soft tissue infections. Am J Surg 179:361–366

    Article  CAS  PubMed  Google Scholar 

  • Elliott DC, Kufera JA, Myers RA (1996) Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg 224:672–683

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Eron LJ, Lipsky BA, Low DE, Nathwani D, Tice AD, Volturo GA (2003) Managing skin and soft tissue infections: expert panel recommendations on key decision points. J Antimicrob Chemother 52(Suppl 1):i3–i17

    Article  PubMed  CAS  Google Scholar 

  • Gherardi G, Vitali LA, Creti R (2018) Prevalent emm types among invasive GAS in Europe and North America since year 2000. Front Public Health 6:59

    Article  PubMed  PubMed Central  Google Scholar 

  • Giuliano A, Lewis F Jr, Hadley K, Blaisdell FW (1977) Bacteriology of necrotizing fasciitis. Am J Surg 134:52–57

    Article  CAS  PubMed  Google Scholar 

  • Hakkarainen TW, Kopari NM, Pham TN, Evans HLHTW et al (2014) Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg 51(8):344–362

    Article  PubMed  PubMed Central  Google Scholar 

  • Hall RL, Callaghan JJ, Moloney E, Martinez S, Harrelson JM (1990) Pyomyositis in a temperate climate. Presentation, diagnosis, and treatment. J Bone Joint Surg Am 72:1240–1244

    Article  CAS  PubMed  Google Scholar 

  • Haywood CT, Mcgeer A, Low DE (1999) Clinical experience with 20 cases of group A streptococcus necrotizing fasciitis and myonecrosis: 1995 to 1997. Plast Reconstr Surg 103:1567–1573

    Article  CAS  PubMed  Google Scholar 

  • Hirose Y, Yamaguchi M, Okuzaki D, Motooka D, Hamamoto H, Hanada T, Sumitomo T, Nakata M, Kawabata S (2019) Streptococcus pyogenes Transcriptome changes in the inflammatory environment of necrotizing fasciitis. Appl Environ Microbiol 85:e01428–e01419

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Horseman MA, Surani S (2011) A comprehensive review of Vibrio vulnificus: an important cause of severe sepsis and skin and soft-tissue infection. Int J Infect Dis 15:e157–e166

    Article  PubMed  Google Scholar 

  • Hsiao CT, Weng HH, Yuan YD, Chen CT, Chen IC (2008) Predictors of mortality in patients with necrotizing fasciitis. Am J Emerg Med 26:170–175

    Article  PubMed  Google Scholar 

  • Huang KF, Hung MH, Lin YS, Lu CL, Liu C, Chen CC, Lee YH (2011) Independent predictors of mortality for necrotizing fasciitis: a retrospective analysis in a single institution. J Trauma 71:467–473

    Article  PubMed  Google Scholar 

  • Huang K-C, Weng H-H, Yang T-Y, Chang T-S, Huang T-W, Lee MC (2016) Distribution of fatal Vibrio vulnificus necrotizing skin and soft-tissue infections. Medicine 95:e2627

    Article  PubMed  PubMed Central  Google Scholar 

  • Ikebe T, Murayama S, Saitoh K, Yamai S, Suzuki R, Isobe J, Tanaka D, Katsukawa C, Tamaru A, Katayama A, Fu**aga Y, Hoashi K, Watanabe H, Working Group for Streptococci in Japan (2004) Surveillance of severe invasive group-G streptococcal infections and molecular ty** of the isolates in Japan. Epidemiol Infect 2004(132):145–149

    Article  CAS  Google Scholar 

  • Kachroo P, Eraso JM, Olsen RJ, Zhu L, Kubiak SL, Pruitt L, Yerramilli P, Cantu CC, Ojeda Saavedra M, Pensar J, Corander J, Jenkins L, Kao L, Granillo A, Porter AR, Deleo FR, Musser JM (2020) New pathogenesis mechanisms and translational leads identified by multidimensional analysis of necrotizing myositis in primates. mBio 11:e03363-19

    Article  PubMed  PubMed Central  Google Scholar 

  • Kaul R, McGeer A, Low DE, Green K, Schwartz B (1997) Population-based surveillance for group A streptococcal necrotizing fasciitis: clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Ontario group A streptococcal study. Am J Med 103:18–24

    Article  CAS  PubMed  Google Scholar 

  • Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Yodluangfun S, Tantraworasin A (2015) Necrotizing fasciitis: risk factors of mortality. Risk Manag Health Policy 16:1–7

    Google Scholar 

  • Kim D-M, Jung S-I, Jang H-C, Lee CS, Lee SH, Yun NR, Neupane GP, Park K-H (2011) Vibrio vulnificus DNA load and mortality. J Clin Microbiol 49:413–415

    Article  PubMed  Google Scholar 

  • Kim T, Park SY, Kwak YG, Jung J, Kim MC, Choi SH, Yu SN, Hong HL, Kim YK, Park SY, Song EH, Park KH, Cho OH, Choi SH, Korean SSTI Study Group (2019) Etiology, characteristics, and outcomes of community-onset necrotizing fasciitis in Korea: a multicenter study. PLoS One 14:e0218668

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kobayashi L, Konstantinidis A, Shackelford S, Chan LS, Talving P, Inaba K, Demetriades D (2011) Necrotizing soft tissue infections: delayed surgical treatment is associated with increased number of surgical debridements and morbidity. J Trauma 71:1400–1405

    Article  PubMed  Google Scholar 

  • Lamb LEM, Sriskandan S, Tan TK (2015) Bromine, bear-claw scratch fasciotomies, and the eagle effect: management of group A streptococcal necrotising fasciitis and its association with trauma. Lancet Infect Dis 15:109–121

    Article  PubMed  Google Scholar 

  • Lancefield RC (1933) A serological differentiation of human and other groups of Hemolytic streptococci. J Exp Med 57:571–595

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lancefield RC, Hare R (1935) The serological differentiation of pathogenic and non-pathogenic strains of hemolytic streptococci from parturient women. J Exp Med 61:335–349

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lee CY, Kuo LT, Peng KT, Hsu WH, Huang TW, Chou YC (2011) Prognostic factors and monomicrobial necrotizing fasciitis: gram-positive versus gram-negative pathogens. BMC Infect Dis 11:5

    Article  PubMed  PubMed Central  Google Scholar 

  • Lee TC, Carrick MM, Bradford GS, Hodges JC, Pham HQ (2007) Incidence and clinical characteristics of methicillin-resistant Staphylococcus aureus necrotizing fasciitis in a large urban hospital. Am J Surg 194:809–813

    Article  PubMed  Google Scholar 

  • Lin JN, Chang LL, Lai CH, Lin HH, Chen YH (2013) Group A streptococcal necrotizing fasciitis in the emergency department. J Emerg Med 45:781–788

    Article  PubMed  Google Scholar 

  • Louis A, Savage S, Utter GH, Li SW, Crandall M (2019) NSTI organisms and regions: a Multicenter study from the American Association for the Surgery of Trauma. J Surg Res 243:108–113

    Article  PubMed  Google Scholar 

  • Madsen MB (2018) Thesis. Necrotizing soft tissue infections in the ICU. University of Copenhagen, Denmark

    Google Scholar 

  • Madsen MB, Skrede S, Perner A, Arnell P, Nekludov M, Bruun T, Karlsson Y, Hansen MB, Polzik P, Hedetoft M, Rosén A, Saccenti E, Bergey F, Martins Dos Santos VAP, Norrby-Teglund A, Hyldegaard O, Infect Study Group (2019) Patient’s characteristics and outcomes in necrotising soft-tissue infections: results from a Scandinavian, multicentre, prospective cohort study. Intensive Care Med 45:1241–1251

    Article  CAS  PubMed  Google Scholar 

  • Marwick C, Broomhall J, McCowan C, Phillipsm G, Gonzalez-Mcquire S, Akhras K, Merchant S, Nathwani D, Davey P (2011) Severity assessment of skin and soft tissue infections: cohort study of management and outcomes for hospitalized patients. J Antimicrob Chemother 66:387–397

    Article  CAS  PubMed  Google Scholar 

  • McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA (1995) Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 221:558–563

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Miller LC, Perdreau-Remington F, Rieg G, Mehdi S, Perlroth J, Bayer AS, Tang AW, Phung TO, Spellberg B (2005) Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med 352:1445–1453

    Article  CAS  PubMed  Google Scholar 

  • Monnickendam MA, McEvoy MB, Blake WA, Gaworzewska ET, Hallas G, Tanna A, Efstratiou A, George RC (1997) Necrotising fasciitis associated with invasive group A streptococcal infections in England and Wales. Adv Exp Med Biol 418:87–89

    Article  CAS  PubMed  Google Scholar 

  • Morgan M (2010) Diagnosis and management of necrotizing fasciitis: a multiparametric approach. J Hosp Infect 75:249–257

    Article  CAS  PubMed  Google Scholar 

  • Musser JM, Beres SB, Zhu L, Olsen RJ, Vuopio J, Hyyryläinen HL, Gröndahl-Yli-Hannuksela K, Kristinsson KG, Darenberg J, Henriques-Normark B, Hoffman S, Caugant DA, Smith AJ, Lindsay DSJ, Boragine DM, Palzkill T (2020) Reduced in vitro susceptibility of Streptococcus pyogenes to β-lactam antibiotics associated with mutations in the pbp2x gene is geographically widespread. J Clin Microbiol 58:e01993-19. https://doi.org/10.1128/JCM.01993-19

    Article  PubMed  PubMed Central  Google Scholar 

  • Nagy E, Urbán E, Nord CE, ESCMID Study Group on Antimicrobial Resistance in Anaerobic Bacteria (2011) Antimicrobial susceptibility of Bacteroides fragilis group isolates in Europe: 20 years of experience. Clin Microbiol Infect 17:371–379

    Article  CAS  PubMed  Google Scholar 

  • Onderdonk AB, Garrett WS (2010) Gas gangrene and other Clostridium-associated diseases. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases, 7th edn, Philadelphia, PA

    Google Scholar 

  • Oppegaard O, Mylvaganam H, Kittang BR (2015) Beta-haemolytic group A, C and G streptococcal infections in Western Norway: a 15-year retrospective survey. Clin Microbiol Infect 21:171–178

    Article  CAS  PubMed  Google Scholar 

  • Peetermans M, de Prost N, Eckmann C, Norrby-Teglund A, Skrede S, De Waele JJ (2020) Necrotizing skin and soft-tissue infections in the intensive care unit. Clin Microbiol Infect 26(1):8–17

    Article  CAS  PubMed  Google Scholar 

  • Piotrowska H, Popowska M (2014) The prevalence of antibiotic resistance genes among Aeromonas species in aquatic environments. Ann Microbiol 64:921–934

    Article  CAS  Google Scholar 

  • Poeschl PW, Spusta L, Russmueller G, Seemann R, Hirschl A, Poeschl E, Klug C, Ewers R (2010) Antibiotic susceptibility and resistance of the odontogenic microbiological spectrum and its clinical impact on severe deep space head and neck infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 110:151–156

    Article  PubMed  Google Scholar 

  • Ralph AP, Carapetis JR (2013) Group a streptococcal diseases and their global burden. Curr Top Microbiol Immunol 368:1–27

    CAS  PubMed  Google Scholar 

  • Rello J, Van Engelen TSR, Alp E, Calandra T, Cattoir V, Kern WV, Netea MG, Nseir S, Opal SM, Van Verdonk FL, Wilcox MH, Wiersinga WJ (2018) Towards precision medicine in sepsis: a position paper from the European Society of Clinical Microbiology and Infectious Diseases. Clin Microbiol Infect 24:1264–1272

    Article  CAS  PubMed  Google Scholar 

  • Rosén A, Arnell P, Bergey F, Madsen MB, Norrby-Teglund A, Hyldegaard O, Martins Dos Santos, V.A.P., Saccenti, E. & Skrede, S; Infect Study Group. (2020) Diabetes and necrotizing soft tissue infections – a prospective observational Scandinavian multicentre study. Submitted manuscript

    Google Scholar 

  • Rudkjøbing VB, Thomsen TR, Xu Y, Melton-Kreft R, Ahmed A, Eickhardt S, Bjarnsholt T, Poulsen SS, Nielsen PH, Earl JP, Ehrlich GD, Moser C (2016) Comparing culture and molecular methods for the identification of microorganisms involved in necrotizing soft tissue infections. BMC Infect Dis 16:652

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Saeed K, Esposito S, Gould I, Ascione T, Bassetti M, Bonnet E, Bouza E, Chan M, Davis JS, De Simeone G, Dryden M, Gottlieb T, Hijazi K, Lye DC, Pagliano P, Petridou C, Righi E, Segreti J, Unal S, Yalcin AN, International Society of Antimicrobial Chemotherapy (2018) Hot topics in necrotising skin and soft tissue infections. Int J Antimicrob Agents 52:1–10

    Article  CAS  PubMed  Google Scholar 

  • Sarani B, Strong M, Pascual J, Schwab W (2009) Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg 208:279–288

    Article  PubMed  Google Scholar 

  • Sartelli M et al (2018) 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections. World J Emerg Surg 13:58

    Article  PubMed  PubMed Central  Google Scholar 

  • Sharkawy A, Low DE, Saginur R, Gregson D, Schwartz B, Jessamine P, Green K, McGeer A, Ontario Group A Streptococcal Study Group (2002) Severe group a streptococcal soft-tissue infections in Ontario: 1992–1996. Clin Infect Dis 34:454–460

    Article  PubMed  Google Scholar 

  • Sharma M, Khatib R, Fakih M (2002) Clinical characteristics of necrotizing fasciitis caused by group G streptococcus: case report and review of the literature. Scand J Infect Dis 34:468–471

    Article  PubMed  Google Scholar 

  • Shimomura Y, Okumura K, Murayama SY, Yagi J, Ubukata K, Kirikae T, Miyoshi-Akiyama T (2011) Complete genome sequencing and analysis of a Lancefield group G Streptococcus dysgalactiae subsp. equisimilis strain causing streptococcal toxic shock syndrome (STSS). BMC Genomics 12:17

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Shumba P, Mairpady SS, Siemens N (2019) The role of streptococcal and staphylococcal exotoxins and proteases in human necrotizing soft tissue infections. Toxins 11:E332

    Article  PubMed  CAS  Google Scholar 

  • Siemens N, Chakrakodi B, Shambat SM, Morgan M, Bergsten H, Hyldegaard O, Skrede S, Arnell P, Madsen MB, Johansson L, INFECT Study Group, Juarez J, Bosnjak L, Mörgelin M, Svensson M, Norrby-Teglund A, Siemens N et al (2016) Biofilm in group A streptococcal necrotizing soft tissue infections. JCI Insight 1(10):e87882. https://doi.org/10.1172/jci.insight.87882. PMID: 27699220

  • Smit PW, Lindholm L, Lyytikainen O, Jalava J, Pätäri-Sampo A, Vuopio J (2015) Epidemiology and emm types of invasive group A streptococcal infections in Finland, 2008–2013. Eur J Clin Microbiol Infect Dis 34:2131–2136

    Article  CAS  PubMed  Google Scholar 

  • Stacy A, McNally L, Darch SE, Brown SP, Whiteley M (2016) The biogeography of polymicrobial infection. Nat Rev Microbiol 14:93–105

    Article  CAS  PubMed  Google Scholar 

  • Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC, Infectious Diseases Society of America (2014) Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 59:147–159. and Clin Infect Dis 59:e10-52. Erratum in: Clin Infect Dis 2015;60:1448

    Article  PubMed  Google Scholar 

  • Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJC, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC (2005) Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 41:1373-1406. Erratum in: Clin Infect Dis 2005;15:1830 and Clin Infect Dis 2006;42:1219

    Google Scholar 

  • Stevens DL, Bryant AE (2002) The role of clostridial toxins in the pathogenesis of gas gangrene. Clin Infect Dis 35:S93–S100

    Article  CAS  PubMed  Google Scholar 

  • Stevens DL, Bryant AE (2017) Necrotizing soft-tissue infections. N Engl J Med 377

    Google Scholar 

  • Stevens DL, Bryant AE (2020) Clostridial myonecrosis. In: Bartlett JE (ed) UpToDate®. retrieved March 26, 2020 https://www.uptodate.com/contents/clostridial-myonecrosis

    Google Scholar 

  • Takahashi T, Sunaoshi K, Sunakawa K, Fujishima S, Watanabe H, Ubukata K, Invasive Streptocooccal Disease Working Group (2010) Clinical aspects of invasive infections with Streptococcus dysgalactiae ssp. equisimilis in Japan: differences with respect to Streptococcus pyogenes and Streptococcus agalactiae infections. Clin Microbiol Infect 16:1097–1103

    Article  CAS  PubMed  Google Scholar 

  • Thapaliya D, O’Brien AM, Wardyn SE, Smith TC (2015) Epidemiology of necrotizing infection caused by Staphylococcus aureus and Streptococcus pyogenes at an Iowa hospital. J Infect Public Health 8:634–641

    Article  PubMed  Google Scholar 

  • Thänert R, Itzek A, Hoßmann J, Hamisch D, Madsen MB, Hyldegaard O, Skrede S, Bruun T, Norrby-Teglund A, Medina E, Pieper DH, INFECT STUDY GROUP (2019) Molecular profiling of tissue biopsies reveals unique signatures

    Google Scholar 

  • Tsai Y-H, Shen S-H, Yang T-Y, Chen P-H, Huang K-C, Lee MS (2015) Monomicrobial necrotizing fasciitis caused by Aeromonas hydrophila and Klebsiella pneumonia. Med Princ Pract 24:416–423

    Article  PubMed  PubMed Central  Google Scholar 

  • Tsai YH, Chen PH, Yu PA, Chen CL, Kuo LT, Huang KC (2019) A multiplex PCR assay for detection of Vibrio vulnificus, Aeromonas hydrophila, methicillin-resistant Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus agalactiae from the isolates of patients with necrotizing fasciitis. Int J Infect Dis 81:73–80

    Article  CAS  PubMed  Google Scholar 

  • Vannice K, Ricaldi J, Nanduri S, Fang FC, Lynch J, Bryson-Cahn C, Wright T, Duchin J, Kay M, Chochua S, Van Beneden C, Beall B (2019) Streptococcus pyogenes pbp2x mutation confers reduced susceptibility to β-lactam antibiotics. Clin Infect Dis. https://doi.org/10.1093/cid/ciz1000

  • Zhao-Fleming HH, Wilkinson JE, Larumbe E, Dissanaike S, Rumbaugh K (2019) Obligate anaerobes are abundant in human necrotizing soft tissue infection samples – a metagenomics analysis. APMIS 127:577–587

    Article  PubMed  PubMed Central  Google Scholar 

  • Zeppa JJ, Kasper KJ, Mohorovic I, Mazzuca DM, Haeryfar SMM, Mccormick JK (2017) Nasopharyngeal infection by Streptococcus pyogenes requires superantigen-responsive Vβ-specific T cells. Proc Natl Acad Sci U S A 114:10226–10231

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgment

This work was supported by the European Union Seventh Framework Programme: (FP7/2007-2013) under the grant agreement 305340 (INFECT project), NordForsk (Project no. 90456, PerAID), the Norwegian Research Council under the frame of ERA PerMed (Project 2018-151, PerMIT) and The Swedish Research Council Framework Grant in infections and antibiotics (2014-8609-117204-47).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Steinar Skrede .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Skrede, S., Bruun, T., Rath, E., Oppegaard, O. (2020). Microbiological Etiology of Necrotizing Soft Tissue Infections. In: Norrby-Teglund, A., Svensson, M., Skrede, S. (eds) Necrotizing Soft Tissue Infections. Advances in Experimental Medicine and Biology, vol 1294. Springer, Cham. https://doi.org/10.1007/978-3-030-57616-5_5

Download citation

Publish with us

Policies and ethics

Navigation