Aplicação do Índice LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) na distinção entre infecções complicadas da pele e tecidos moles e infecções necrotizantes

  • Aline Estela Medeiros Gomes Interna do 6.º ano de Cirurgia Geral Serviço de Cirurgia 1 do Centro Hospitalar de Tondela – Viseu, E.P.E.
  • Milene Raquel Sá Interna do 3.º ano de Cirurgia Geral Serviço de Cirurgia 1 do Centro Hospitalar de Tondela – Viseu, E.P.E.
  • Maria Conceição Guedes Marques Assistente Graduada de Cirurgia Geral Serviço de Cirurgia 1 do Centro Hospitalar de Tondela – Viseu, E.P.E.
  • Luis Filipe Pinheiro Director de Serviço Serviço de Cirurgia 1 do Centro Hospitalar de Tondela – Viseu, E.P.E.

Resumo

A infecção necrotizante é a forma mais grave de infecção da pele e dos tecidos moles, rapidamente progressiva e frequentemente letal se não for diagnosticada e tratada precocemente. No entanto, num estadio inicial, a clínica é semelhante às outras infecções da pele e tecidos moles graves, e o diagnóstico baseia-se essencialmente num elevado nível de suspeição. O índice de LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) foi elaborado para avaliar o risco de um doente estar a desenvolver uma infecção necrotizante, e deste modo ser um instrumento útil nesta fase inicial. Os autores propuseram-se a realizar um estudo retrospectivo de todas as infecções da pele e tecidos moles complicadas admitidas em internamento entre Outubro de 2004 e Outubro de 2009. Neste período foram admitidos 327 doentes com infecções complicadas, dos quais 313 apresentavam infecções complicadas não necrotizantes e 14 infecções necrotizantes. O índice de LRINEC foi aplicado a 282 doentes mostrando, nesta série, que este seria um instrumento válido e com elevada sensibilidade (92,8%) para o diagnóstico das infecções necrotizantes.

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Referências

1. Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJC, et al. Practice Guidelines for the Diagnosis and Management
of Skin and Soft-Tissue Infections. Clin Infect Dis. 2005 Nov 15;41(10):1373-406.

2. Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: Review and current concepts in treatment, systems
of care, and outcomes. Curr Probl Surg. 2014 Aug;51(8):344-62.

3. May AK. Skin and soft tissue infections: the new surgical infection society guidelines. Surg Infect. 2011 Jun;12(3):179-84.

4. May AK, Stafford RE, Bulger EM, Heffernan D, Guillamondegui O, Bochicchio G, et al. Treatment of Complicated Skin and Soft Tissue
Infections. Surg Infect. 2009 Oct;10(5):467-99.

5. May AK, Stafford RE, Bulger EM, Heffernan D, Guillamondegui O, Bochicchio G, et al. Treatment of complicated skin and soft tissue
infections. Surg Infect. 2009 Oct;10(5):467-99.

6. Sartelli M, Malangoni MA, May AK, Viale P, Kao LS, Catena F, et al. World Society of Emergency Surgery (WSES) guidelines for management
of skin and soft tissue infections. World J Emerg Surg. 2014;9(1):57.

7. Wall DB, de Virgilio C, Black S, Klein SR. Objective criteria may assist in distinguishing necrotizing fasciitis from nonnecrotizing soft tissue
infection. Am J Surg. 2000 Jan;179(1):17-21.

8. DiNubile MJ, Lipsky BA. Complicated infections of skin and skin structures: when the infection is more than skin deep. J Antimicrob
Chemother. 2004 Jun;53 Suppl 2:ii37-50.

9. Wong C-H, Khin L-W, Heng K-S, Tan K-C, Low C-O. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: A tool for
distinguishing necrotizing fasciitis from other soft tissue infections*. Crit Care Med. 2004 Jul;32(7):1535-41.

10. Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis Off Publ Infect Dis Soc Am. 2007
Mar 1;44(5):705-10.

11. Barie PS. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score: Useful tool or paralysis by analysis?*. Crit Care Med.
2004 Jul;32(7):1618-9.

12. Wong C-H, Khin L-W. Clinical Relevance of the LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) Score for Assessment of
Early Necrotizing Fasciitis. Crit Care Med. 2005 Jul;33(7):1677.

13. Dryden MS. Skin and soft tissue infection: microbiology and epidemiology. Int J Antimicrob Agents. 2009 Jul;34 Suppl 1:S2-7.

14. Edelsberg J. Trends in US Hospital Admissions for Skin and Soft Tissue Infections. Emerg Infect Dis. 2009 Sep;1516-8.

15. Rajan S. Skin and soft-tissue infections: Classifying and treating a spectrum. Cleve Clin J Med. 2012 Jan 4;79(1):57-66.

16. Ellis Simonsen SM, Van Orman ER, Hatch BE, Jones SS, Gren LH, Hegmann KT, et al. Cellulitis incidence in a defined population. Epidemiol
Infect. 2005 Sep 7;134(02):293.

17. File TM Jr, Tan JS, DiPersio JR. Group A streptococcal necrotizing fasciitis. Diagnosing and treating the “flesh-eating bacteria syndrome.”
Cleve Clin J Med. 1998 May;65(5):241-9.

18. Kaul R, McGeer A, Low DE, Green K, Schwartz B. 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. 1997
Jul;103(1):18-24.

19. Cheung JPY, Fung B, Tang WM, Ip WY. A review of necrotising fasciitis in the extremities. Hong Kong Med J Xianggang Yi Xue Za Zhi Hong Kong Acad Med. 2009 Feb;15(1):44-52.

20. Shimizu T, Tokuda Y. Necrotizing Fasciitis. Intern Med. 2010;49(12):1051-7.

21. Leitch HA, Palepu A, Fernandes CM. Necrotizing fasciitis secondary to group A streptococcus. Morbidity and mortality still high. Can Fam
Physician Médecin Fam Can. 2000 Jul;46:1460-6.

22. Kotrappa KS, Bansal RS, Amin NM. Necrotizing fasciitis. Am Fam Physician. 1996 Apr;53(5):1691-7.

23. Morgan MS. Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect. 2010 Aug;75(4):249-57.

24. Smeets L, Bous A, Heymans O. Necrotizing fasciitis: case report and review of literature. Acta Chir Belg. 2007 Feb;107(1):29-36.

25. Wang Y-S, Wong C-H, Tay Y-K. Staging of necrotizing fasciitis based on the evolving cutaneous features. Int J Dermatol. 2007 Oct;46(10):1036-41.

26. Edlich RF, Cross CL, Dahlstrom JJ, Long WB 3rd. Modern concepts of the diagnosis and treatment of necrotizing fasciitis. J Emerg Med. 2010 Aug;39(2):261-5.

27. Malghem J, Lecouvet FE, Omoumi P, Maldague BE, Vande Berg BC. Necrotizing fasciitis: Contribution and limitations of diagnostic imaging. Joint Bone Spine [Internet]. 2012 Oct [cited 2012 Oct 20]; Available from: http://linkinghub.elsevier.com/retrieve/pii/ S1297319X12001996

28. Kaafarani HMA, King DR. Necrotizing Skin and Soft Tissue Infections. Surg Clin North Am. 2014 Feb;94(1):155-63.

29. Frank J, Barker JH, Marzi I. Necrotizing Fasciitis of the Extremities. Eur J Trauma Emerg Surg. 2008 May 30;34(3):229-36.

30. Carter PS, Banwell PE. Necrotising fasciitis: a new management algorithm based on clinical classification. Int Wound J. 2004 Sep;1(3):189-98.

31. Roje Z, Roje Z, Matić D, Librenjak D, Dokuzović S, Varvodić J. Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs. World J Emerg Surg WJES. 2011;6(1):46.

32. Young MH, Aronoff DM, Engleberg NC. Necrotizing fasciitis: pathogenesis and treatment. Expert Rev Anti Infect Ther. 2005 Apr;3(2):279-94.

33. Puvanendran R, Huey J, Pasupathy S. Necrotizing fasciitis. Can Fam Physician. 2009 Outubro;55(10):981-7.

34. Young MH, Engleberg NC, Mulla ZD, Aronoff DM. Therapies for necrotising fasciitis. Expert Opin Biol Ther. 2006 Feb;6(2):155-65.

35. Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing Fasciitis: Current Concepts and Review of the Literature. J Am Coll Surg. 2009 Feb;208(2):279-88.

36. Liao C-I, Lee Y-K, Su Y-C, Chuang C-H, Wong C-H. Validation of the laboratory risk indicator for necrotizing fasciitis (LRINEC) score for early diagnosis of necrotizing fasciitis. Tzu Chi Med J. 2012 Jun;24(2):73-6.

37. Goldstein EJC, Anaya DA, Dellinger EP. Necrotizing Soft-Tissue Infection: Diagnosis and Management. Clin Infect Dis. 2007 Mar 1;44(5):705-10.

38. Holland MJ. Application of the Laboratory Risk Indicator in Necrotising Fasciitis (LRINEC) score to patients in a tropical tertiary referral centre. Anaesth Intensive Care. 2009 Jul;37(4):588-92.
Publicado
2016-06-30
Como Citar
GOMES, Aline Estela Medeiros et al. Aplicação do Índice LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) na distinção entre infecções complicadas da pele e tecidos moles e infecções necrotizantes. Revista Portuguesa de Cirurgia, [S.l.], n. 37, p. 9 - 16, jun. 2016. ISSN 2183-1165. Disponível em: <https://revista.spcir.com/index.php/spcir/article/view/580>. Acesso em: 15 nov. 2019.
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