Insufficient data concerning therapeutic management of necrotizing soft-tissue infections

SOURCE
Hua C, Bosc R, Sbidian E, et al. (2018). Interventions for necrotizing soft tissue infections in adults.  Cochrane Database Syst Rev5:CD011680

CONTEXT
The necrotizing soft-tissue infection is a rare pathology of bacterial origin with high morbidity and mortality, which requires multidisciplinary management. Standard management includes empiric intravenous antibiotic therapy, early surgical debridement of necrotic tissues, intensive care support and adjuvant therapies such as intravenous immunoglobulin.

CLINICAL QUESTION
What are the effects of treatments for necrotizing soft-tissue infections in adults in a hospital setting?

BOTTOM LINE
Three randomized trials were included, and the mean age of the subjects was 55 years: moxifloxacin vs. amoxicillin-clavulanate, AB103 vs.placebo, and intravenous immunoglobulin vs. placebo. In all three trials,interventional treatment options were performed concurrently with standard management.
No significant differences were observed in each trial for the rate of mortality in 30 days, and the rate of serious adverse events in 28 days (very low level of evidence).

CAVEAT
This systematic review of randomized trials is based on a low number of patients and includes a high risk of bias. Inclusion criteria should be more clearly defined in future trials.Observational studies may be evaluated for inclusion if they assess key outcomes,such as mortality (in the acute phase) and quality of life (in the chronic phase) in the future.

AUTHOR INFORMATION

Patricia JABRE
SAMU de Paris, CHU Necker-Enfants Malades
Paris, France
patricia.jabre@aphp.fr

Sébastien BEROUD
Hospices civils de Lyon, CHU Lyon-Sud,
Lyon, France
sebastien.beroud@chu-lyon.fr

Haldun AKOGLU
Marmara University School of Medicine
Istanbul, Turkey
haldun.akoglu@marmara.edu.tr