Fasciitis

丁香园病例库经过同行推荐，收录超过 5 万篇来自临床真实经验、汇聚精华点评的真实病例，供更多的医生朋友学习讨论、临床借鉴。比如丁香园站友 @肖申克的二叔 分享的这篇，就在病例库里引起了广泛热议。患者：男，62 岁。简要病史：患者 5 天前因牙周疾病行拔牙治疗，治疗后 5 天患者开始出现颈肩部肿胀疼痛，遂于口腔诊所抗生素治疗。治疗 5 日后患者症状无明显缓解，遂于某区医院就诊，并给予患者肩部胸部切开引流治疗。术后 1 周患者持续发热，转入我院急诊，并收入我科治疗。急诊 CT：可见颈部、右侧胸壁、右侧腋中线、右上肢广泛皮下坏死。术中所见：全麻下急诊行坏死性筋膜炎清除 + 皮肤及皮下组织清创术。切开后筋膜层到处流脓，手术持续了 2 个多小时。▲图片已做打码处理，可点击「阅读全文」查看原图拔牙为何会引起如此严重的后果？如果是你接诊此患者，你会怎么做？楼主已在原帖补充了后续，站友在评论区也分享了类似的病例，欢迎来丁香园社区参与讨论并发表你的观点。文内素材及图片来源：丁香园社区👇 点击【阅读原文】查看完整病例，参与讨论！

TUESDAY, April 8, 2025 -- Severe and possibly deadly strep infections are on the rise in the U.S., a study published Monday in Journal of the American Medical Association said. The rate of invasive group A strep infections more than doubled from 2013 to 2022, jumping from about 4 cases per 100,000 people to 8 per 100,000, NBC News reported. These infections happen when strep bacteria spread to normally germ-free parts of the body, such as the lungs or bloodstream. Unlike regular strep throat, this type can lead to dangerous conditions like necrotizing fasciitis (flesh-eating disease) or toxic shock syndrome. “Within 24 to 48 hours, you could have very, very rapid deterioration,” Dr. Victor Nizet , a professor of pediatrics at the University of California, San Diego, told NBC News . Cases can transition from "seeming like a routine flu-like illness to rushing the patient to the ICU, fearing for their recovery,” he added. The U.S. Centers for Disease Control and Prevention (CDC) tracked data from 10 states with about 35 million people. In 2013, there were 1,082 cases. By 2022, there were 2,759 cases. In all, more than 21,000 cases were recorded over the period, including nearly 2,000 deaths, NBC News said. “When you see this high number of deaths, extrapolate that across the country — we’re probably well into more than 10,000 deaths,” Nizet said. Dr. Christopher Gregory , a CDC researcher and co-author of the study, said invasive strep now poses a higher threat to both high-risk groups and the general population. The rise may be linked to several issues: For one, more people are living with diabetes or obesity, which weakens the immune system. There's also been a rise in infections among people who inject drugs or experience homelessness. In 2022, the rate of infection among homeless people was 807 per 100,000 — one of the highest ever recorded, NBC News said. Gregory said the rate was “among the highest ever documented worldwide.” Also, strep strains are changing. New strains seem to cause more skin infections, not just sore throats, and some are becoming resistant to antibiotics like macrolides and clindamycin . The infection rate was highest among adults 65 and older, and all adults saw increases. Surprisingly, though, the study didn’t find an overall increase in children, but doctors say they’re seeing more serious cases. “That was, to me, the most shocking part of the study,” said Dr. Allison Eckard , division chief for pediatric infectious diseases at the Medical University of South Carolina. “Because clinically, we really are seeing what feels like an increase." Eckard, who reviewed the findings, said doctors are seeing more severe and more unusual cases, as well as more necrotizing fasciitis. It all raises concern, she said, that and cases "there is something going on more nationally.” She and other experts say more research is needed to understand what’s causing the rise and whether strep strains are becoming more dangerous. They also say a vaccine is badly needed, but progress may be slow due to recent changes at the U.S. Food and Drug Administration (FDA). “The lack of vaccine is devastating,” Nizet concluded. “Of course, we’re concerned about the turn of attitudes at the FDA and the CDC that seem to be putting some sticks in the spokes of the wheel of vaccine development.” Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

Recce Pharmaceuticals has shared positive data from a mid-stage study of its RECCE 327 topical gel (R327G) in acute bacterial skin and skin structure infections (ABSSSIs). The open-label phase 2 trial has been evaluating the safety and efficacy of the candidate when applied directly to the infected area in adults with ABSSSIs, including those with diabetic foot infections (DFIs). After seven days of treatment, 86% of R327G-treated patients had a successful clinical response and, after 14 days, 93% achieved a primary efficacy endpoint. R327G was also shown to be safe and well tolerated, with no serious adverse events reported. Recce said the data confirms the approach for its approved registrational phase 3 DFIs study in Indonesia, adding that it is also expecting to initiate a registrational phase 3 trial in Australia for ABSSSIs and DFIs. ABSSSIs, including DFIs, necrotising fasciitis and post-operative wound infections, are considered a significant healthcare concern, and there is an increased demand from the US Food and Drug Administration for new broad-spectrum antibiotics to address antimicrobial resistance (AMR). Declared by the World Health Organization (WHO) as one of the top ten threats to global health, AMR occurs when bacteria, viruses, fungi and parasites change over time and resist the effects of antimicrobial drugs. As a result, infections become harder to treat and the risk of disease spread, severe illness and death increases. Recce’s chief executive officer, James Graham, said: “These impressive results underscore the potential of our topical gel to meet critical unmet medical needs in infection treatment. “As we advance towards registrational phase 3 trials in Indonesia and Australia, we are encouraged by the rapid efficacy and strong safety outcomes demonstrated in this study.” Sharing a similar sentiment, Alan Dunton, director and chief medical advisor at Recce, said: “These results reflect the broad-spectrum nature and rapid onset of the effect of R327G, which positions us well for the upcoming phase 3 trials in Indonesia and Australia.” WHO has already added R327, along with two other anti-infectives in Recce’s pipeline, to its list of antibacterial products in clinical development for priority pathogens. The FDA has also granted R327 Qualified Infectious Disease Product designation under its Generating Antibiotic Initiatives Now Act, providing Fast Track Designation to the treatment as well as ten years of market exclusivity following approval.