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Vol. 4. Núm. S2.
Monográfico: Infección y patologías microcristalinas
Páginas 35-40 (octubre 2008)
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Vol. 4. Núm. S2.
Monográfico: Infección y patologías microcristalinas
Páginas 35-40 (octubre 2008)
Infección y patologías microcristalinas
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Infección de partes blandas
Soft-Tissue Infections
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Miguel Ángel Abad Hernández
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miguelangel.abad@ses.juntaex.es

Correspondencia: Dr. M.A. Abad Hernández. Paraje de Valcorchero, s/n. 10600 Plasencia. Caceres. España.
Unidad de Reumatología. Hospital Virgen del Puerto. Plasencia. Cáceres. España
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Las infecciones de partes blandas con mayor relevancia clínica son la fascitis necrosante, producida por Streptococcus pyogenes, y las infecciones cutáneas producidas por Staphylococcus aureus, particularmente por las cada vez más frecuentes formas resistentes a la meticilina (SARM).

En la fascitis necrosante, el retraso diagnóstico y la demora en la indicación de desbridamiento quirúrgico marcan el pronóstico y la alta mortalidad de estas infecciones. Se han descrito dos formas clínicas: la tipo I, causada por al menos una especie anaerobia en combinación con anaerobios facultativos, más frecuentes en diabéticos o con enfermedad vascular periférica; la tipo II, monomicrobiana, producida por estreptococos betahemolíticos del grupo A y, menos frecuentemente, por S. aureus. Los factores de riesgo reconocidos son la diabetes mellitus, la enfermedad vascular periférica grave, la insuficiencia renal crónica, el enolismo, el cáncer, la desnutrición, el tratamiento con corticoides y/o inmunosupresores y la adicción a drogas por vía parenteral. Los pilares terapéuticos son el soporte vital hemodinámico, la terapia antibiótica y el abordaje quirúrgico precoz con extirpación de todo el tejidodesvitalizado y necrosado.

Las infecciones extrahospitalarias por SARM más frecuentes son las de piel y tejidos blandos. Se han descrito algunos grupos de población de riesgo, pero también se constata el aumento en personas sin factores de riesgo. Asimismo, se ha confirmado en los registros nacionales e internacionales de terapias contra el factor de necrosis tumoral el incremento de infecciones de partes blandas en los pacientes con artritis reumatoide tratados con estos agentes. Otros fármacos biológicos, como rituximab, abatacept o anakinra, no parece que tengan relación con un incremento de estas infecciones.

Palabras clave:
Fascitis necrosante
Staphylococcus aureus resistente a la meticilina
Celulitis
Streptococcus pyogenes

One of the soft-tissue infections with a large clinical relevance is necrotizing fascitis produced by Streptococcus pyogenes and skin infections produced by Staphylococcus aureus, particularly due to the evermore frequent methylcillin (MRSA) resistant varieties.

In necrotizing fascitis the diagnostic delay as well as the delay in the indication for surgical debridement influence both the prognosis and a high mortality related to these infections. Two clinical forms have been described: Type I caused by at least one anaerobic species in combination with facultative anaerobes, more frequent in diabetics or patients with peripheral vascular disease; type II, monomicrobial, produced by group A beta hemolytic Streptococcus and with a lesser frequency by Staphylococcus aureus. Among the recognized risk factors diabetes mellitus, peripheral vascular disease, chronic renal failure, alcoholism, cancer, malnutrition, steroid and/or immunosuppressant treatment and the use of intravenous parenteral drugs are widely recognized. Therapeutics is based on hemodynamic support, antibiotic therapy and an early surgical approach with the elimination of all of the necrotic and devitalized tissue.

Infections frequently associated to community-acquired MRSA are those present in skin and soft-tissue. Some population groups have been described as at-risk, but there is also an increase in the number of patients with no risk factors.

Also, national and international registries of anti-TNF therapies have demonstrated the increase of soft-tissue infections in patients with rheumatoid arthritis treated with these agents. Other biologic drugs such as rituximab, abatacept or anakinra do not seem to be associated to an increase in these infections.

Key words:
Necrotizing fascitis
Methylcillin resistant Staphylococcus aureus
Cellulitis
Streptococcus pyogenes
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Copyright © 2008. Elsevier España S.L. Barcelona
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