The Korean Journal of Medicine

  • 제81권6호
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  • Pages.699-707
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  • 2011
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지

피부 및 연조직 감염에서의 항생제 내성 및 최신 치료

Antimicrobial Resistance and Treatment Update of Skin and Soft Tissue Infections

  • 김문석 (서울대학교 의과대학 내과학교실) ;
  • 김남중 (서울대학교 의과대학 내과학교실)
  • Kim, Moon-Suk (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Nam-Joong (Department of Internal Medicine, Seoul National University College of Medicine)
  • 발행 : 2011.12.01
⟨ 이전 논문 다음 논문 ⟩

초록

Soft tissue infections are common, generally of mild to moderate severity. The most common causative organisms of soft tissue infections are group A ${\beta}-hemolytic$ streptococci and Staphylococcus aureus. As the antimicrobial resistance pattern of these causative organisms has not been changed recently, the present recommendations for the treatment of soft tissue infections remain the same. In this review, we have presented extensive information on the clinical characteristics, diagnosis, and treatment of skin and soft tissue infections. We focused on two issues concerning antibiotic resistance; macrolide resistance of group ${\beta}-hemolytic$ streptococci and the emergence of community-acquired methicillin-resistant Staphylococcus aureus.

키워드

참고문헌

  1. Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. N Engl J Med 1996;334:240-245. https://doi.org/10.1056/NEJM199601253340407
  2. Chartier C, Grosshans E. Erysipelas: an update. Int J Dermatol 1996;35:779-781. https://doi.org/10.1111/j.1365-4362.1996.tb02971.x
  3. Bonnetblanc JM, Bedane C. Erysipelas: recognition and management. Am J Clin Dermatol 2003;4:157-163. https://doi.org/10.2165/00128071-200304030-00002
  4. Krasagakis K, Valachis A, Maniatakis P, Kruger-Krasagakis S, Samonis G, Tosca AD. Analysis of epidemiology, clinical features and management of erysipelas. Int J Dermatol 2010;49:1012-1017. https://doi.org/10.1111/j.1365-4632.2010.04464.x
  5. Dupuy A, Benchikhi H, Roujeau JC, et al. Risk factors for erysipelas of the leg (cellulitis): case-control study. BMJ 1999;318:1591-1594. https://doi.org/10.1136/bmj.318.7198.1591
  6. Cox NH. Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg: a series with community follow-up. Br J Dermatol 2006;155:947-950. https://doi.org/10.1111/j.1365-2133.2006.07419.x
  7. Mokni M, Dupuy A, Denguezli M, et al. Risk factors for erysipelas of the leg in Tunisia: a multicenter case-control study. Dermatology 2006;212:108-112. https://doi.org/10.1159/000090649
  8. Bartholomeeusen S, Vandenbroucke J, Truyers C, Buntinx F. Epidemiology and comorbidity of erysipelas in primary care. Dermatology 2007;215:118-122. https://doi.org/10.1159/000104262
  9. Dan M, Heller K, Shapira I, Vidne B, Shibolet S. Incidence of erysipelas following venectomy for coronary artery bypass surgery. Infection 1987;15:107-108. https://doi.org/10.1007/BF01650207
  10. Hinten F, van den Einden LC, Hendriks JC, et al. Risk factors for short- and long-term complications after groin surgery in vulvar cancer. Br J Cancer 2011;105:1279-1287. https://doi.org/10.1038/bjc.2011.407
  11. Chartier C, Grosshans E. Erysipelas. Int J Dermatol 1990;29:459-467. https://doi.org/10.1111/j.1365-4362.1990.tb04833.x
  12. Bernard P, Bedane C, Mounier M, Denis F, Catanzano G, Bonnetblanc JM. Streptococcal cause of erysipelas and cellulitis in adults: a microbiologic study using a direct immunofluorescence technique. Arch Dermatol 1989;125: 779-782. https://doi.org/10.1001/archderm.1989.01670180051004
  13. Eriksson B, Jorup-Ronstrom C, Karkkonen K, Sjoblom AC, Holm SE. Erysipelas: clinical and bacteriologic spectrum and serological aspects. Clin Infect Dis 1996;23:1091-1098. https://doi.org/10.1093/clinids/23.5.1091
  14. Jung HS, Park SE, Lee HJ, Kim EC, Kim JH. Clinical features of infections caused by streptococcus pyogenes in children and their antimicrobial susceptibility. Korean J Infect Dis 1998;30:419-425.
  15. Gracia M, Diaz C, Coronel P, et al. Antimicrobial susceptibility of Streptococcus pyogenes in Central, Eastern, and Baltic European Countries, 2005 to 2006: the cefditoren surveillance program. Diagn Microbiol Infect Dis 2009;64:52-56. https://doi.org/10.1016/j.diagmicrobio.2008.12.018
  16. Torres RS, Torres RP, Smeesters PR, Palmeiro JK, de Messias-Reason IJ, Dalla-Costa LM. Group a streptococcus antibiotic resistance in southern Brazil: a 17-year surveillance study. Microb Drug Resist 2011;17:313-319. https://doi.org/10.1089/mdr.2010.0162
  17. Kilburn SA, Featherstone P, Higgins B, Brindle R. Interventions for cellulitis and erysipelas. Cochrane Database Syst Rev 2010:CD004299.
  18. Jorup-Ronstrom C, Britton S, Gavlevik A, Gunnarsson K, Redman AC. The course, costs and complications of oral versus intravenous penicillin therapy of erysipelas. Infection 1984;12:390-394. https://doi.org/10.1007/BF01645222
  19. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005;41:1373-1406. https://doi.org/10.1086/497143
  20. Bernard P, Plantin P, Roger H. Roxithromycin versus penicillin in the treatment of erysipelas in adults: a comparative study. Br J Dermatol 1992;127:155-159. https://doi.org/10.1111/j.1365-2133.1992.tb08048.x
  21. Jones ME, Karlowsky JA, Draghi DC, Thornsberry C, Sahm DF, Nathwani D. Epidemiology and antibiotic susceptibility of bacteria causing skin and soft tissue infections in the USA and Europe: a guide to appropriate antimicrobial therapy. Int J Antimicrob Agents 2003;22:406-419. https://doi.org/10.1016/S0924-8579(03)00154-7
  22. Richter SS, Heilmann KP, Dohrn CL, et al. Increasing telithromycin resistance among Streptococcus pyogenes in Europe. J Antimicrob Chemother 2008;61:603-611. https://doi.org/10.1093/jac/dkm525
  23. Critchley IA, Sahm DF, Thornsberry C, Blosser-Middleton RS, Jones ME, Karlowsky JA. Antimicrobial susceptibilities of Streptococcus pyogenes isolated from respiratory and skin and soft tissue infections: United States LIBRA surveillance data from 1999. Diagn Microbiol Infect Dis 2002;42:129-135. https://doi.org/10.1016/S0732-8893(01)00327-3
  24. Katz KC, McGeer AJ, Duncan CL, et al. Emergence of macrolide resistance in throat culture isolates of group a streptococci in Ontario, Canada, in 2001. Antimicrob Agents Chemother 2003;47:2370-2372. https://doi.org/10.1128/AAC.47.7.2370-2372.2003
  25. Green M, Martin JM, Barbadora KA, Beall B, Wald ER. Reemergence of macrolide resistance in pharyngeal isolates of group a streptococci in southwestern Pennsylvania. Antimicrob Agents Chemother 2004;48:473-476. https://doi.org/10.1128/AAC.48.2.473-476.2004
  26. Richter SS, Heilmann KP, Beekmann SE, et al. Macrolideresistant Streptococcus pyogenes in the United States, 2002-2003. Clin Infect Dis 2005;41:599-608. https://doi.org/10.1086/432473
  27. Green MD, Beall B, Marcon MJ, et al. Multicentre surveillance of the prevalence and molecular epidemiology of macrolide resistance among pharyngeal isolates of group A streptococci in the USA. J Antimicrob Chemother 2006; 57:1240-1243. https://doi.org/10.1093/jac/dkl101
  28. Michos AG, Bakoula CG, Braoudaki M, et al. Macrolide resistance in Streptococcus pyogenes: prevalence, resistance determinants, and emm types. Diagn Microbiol Infect Dis 2009;64:295-299. https://doi.org/10.1016/j.diagmicrobio.2009.03.004
  29. Koh EH, Maeng KY, Kim S, Jeong HJ, Lee NY. A decrease in erythromycin resistance rate of Streptococcus pyogenes in 2004 in Jinju. Korean J Clin Microbiol 2006;9:51-57.
  30. Uh Y, Hwang GY, Jang IH, et al. Macrolide resistance trends in beta-hemolytic streptococci in a tertiary Korean hospital. Yonsei Med J 2007;48:773-778. https://doi.org/10.3349/ymj.2007.48.5.773
  31. Koh EH, Kim IS, Kim S. T types, emm genotypes and antibiotic resistance of Streptococcus pyogenes isolated from school children in Jinju, 2006. Korean J Clin Microbiol 2009;12:6-10. https://doi.org/10.5145/KJCM.2009.12.1.6
  32. Koh E, Kim S. Decline in erythromycin resistance in group A Streptococci from acute pharyngitis due to changes in the emm genotypes rather than restriction of antibiotic use. Korean J Lab Med 2010;30:485-490. https://doi.org/10.3343/kjlm.2010.30.5.485
  33. Kim EC, Koh EH, Kim S, et al. Multicenter study of molecular epidemiology and antibiotic resistance of group a streptococci in 2008-2009 in Korea. Korean J Clin Microbiol 2011;14:85-90. https://doi.org/10.5145/KJCM.2011.14.3.85
  34. Biedenbach DJ, Toleman MA, Walsh TR, Jones RN. Characterization of fluoroquinolone-resistant beta-hemolytic Streptococcus spp. isolated in North America and Europe including the first report of fluoroquinolone-resistant Streptococcus dysgalactiae subspecies equisimilis: report from the SENTRY antimicrobial surveillance program (1997-2004). Diagn Microbiol Infect Dis 2006;55:119-127. https://doi.org/10.1016/j.diagmicrobio.2005.12.006
  35. Kim JS, Kim HS, Song W, Cho HC, Lee KM, Kim EC. Antimicrobial resistance profiles of Staphylococcus aureus isolated in 13 Korean hospitals. Korean J Lab Med 2004; 24:223-229.
  36. Hong HJ, Lee CH, Park JO, et al. A clinical study on Staphylococcus aureus bacteremia. Korean J Med 1997;53: 359-370.
  37. Park JY, Kim HO, Jeong YG, Kim S, Bae IG. Clinical characteristics and risk factors of community-acquired methicillin-resistant Staphylococcus aureus infections: comparison of community-acquired methicillin-susceptible Staphylococcus aureus infections. Infect Chemother 2006; 38:109-115.
  38. Bergkvist PI, Sjobeck K. Relapse of erysipelas following treatment with prednisolone or placebo in addition to antibiotics: a 1-year follow-up. Scand J Infect Dis 1998;30: 206-207. https://doi.org/10.1080/003655498750003708
  39. Bergkvist PI, Sjobeck K. Antibiotic and prednisolone therapy of erysipelas: a randomized, double blind, placebocontrolled study. Scand J Infect Dis 1997;29:377-382. https://doi.org/10.3109/00365549709011834
  40. Baddour LM, Bisno AL. Recurrent cellulitis after saphenous venectomy for coronary bypass surgery. Ann Intern Med 1982;97:493-496. https://doi.org/10.7326/0003-4819-97-4-493
  41. Baddour LM. Breast cellulitis complicating breast conservation therapy. J Intern Med 1999;245:5-9. https://doi.org/10.1046/j.1365-2796.1999.00404.x
  42. Bouma J, Dankert J. Recurrent acute leg cellulitis in patients after radical vulvectomy. Gynecol Oncol 1988;29:50-57. https://doi.org/10.1016/0090-8258(88)90146-1
  43. Brewer VH, Hahn KA, Rohrbach BW, Bell JL, Baddour LM. Risk factor analysis for breast cellulitis complicating breast conservation therapy. Clin Infect Dis 2000;31:654-659. https://doi.org/10.1086/314021
  44. Hook EW 3rd, Hooton TM, Horton CA, Coyle MB, Ramsey PG, Turck M. Microbiologic evaluation of cutaneous cellulitis in adults. Arch Intern Med 1986;146:295-297. https://doi.org/10.1001/archinte.1986.00360140113016
  45. Perl B, Gottehrer NP, Raveh D, Schlesinger Y, Rudensky B, Yinnon AM. Cost-effectiveness of blood cultures for adult patients with cellulitis. Clin Infect Dis 1999;29:1483-1488. https://doi.org/10.1086/313525
  46. Sigurdsson AF, Gudmundsson S. The etiology of bacterial cellulitis as determined by fine-needle aspiration. Scand J Infect Dis 1989;21:537-542. https://doi.org/10.3109/00365548909037882
  47. Chira S, Miller LG. Staphylococcus aureus is the most common identified cause of cellulitis: a systematic review. Epidemiol Infect 2010;138:313-317. https://doi.org/10.1017/S0950268809990483
  48. Lee JY, Park SD. A study for improvement of the positive culture rate using skin biopsy specimens in patients with cellulitis. Korean J Dermatol 2007;45:134-139.
  49. Sadow KB, Chamberlain JM. Blood cultures in the evaluation of children with cellulitis. Pediatrics 1998;101:E4.
  50. Newell PM, Norden CW. Value of needle aspiration in bacteriologic diagnosis of cellulitis in adults. J Clin Microbiol 1988;26:401-404.
  51. Duvanel T, Auckenthaler R, Rohner P, Harms M, Saurat JH. Quantitative cultures of biopsy specimens from cutaneous cellulitis. Arch Intern Med 1989;149:293-296. https://doi.org/10.1001/archinte.1989.00390020039008
  52. Giordano PA, Elston D, Akinlade BK, et al. Cefdinir vs. cephalexin for mild to moderate uncomplicated skin and skin structure infections in adolescents and adults. Curr Med Res Opin 2006;22:2419-2428. https://doi.org/10.1185/030079906X148355
  53. Hepburn MJ, Dooley DP, Skidmore PJ, Ellis MW, Starnes WF, Hasewinkle WC. Comparison of short-course (5 days) and standard (10 days) treatment for uncomplicated cellulitis. Arch Intern Med 2004;164:1669-1674. https://doi.org/10.1001/archinte.164.15.1669
  54. Grayson ML, McDonald M, Gibson K, et al. Once-daily intravenous cefazolin plus oral probenecid is equivalent to once-daily intravenous ceftriaxone plus oral placebo for the treatment of moderate-to-severe cellulitis in adults. Clin Infect Dis 2002;34:1440-1448. https://doi.org/10.1086/340056
  55. Muijsers RB, Jarvis B. Moxifloxacin in uncomplicated skin and skin structure infections. Drugs 2002;62:967-973. https://doi.org/10.2165/00003495-200262060-00008
  56. Parish LC, Routh HB, Miskin B, et al. Moxifloxacin versus cephalexin in the treatment of uncomplicated skin infections. Int J Clin Pract 2000;54:497-503.
  57. Ramirez-Ronda CH, Saavedra S, Rivera-Vazquez CR. Comparative, double-blind study of oral ciprofloxacin and intravenous cefotaxime in skin and skin structure infections. Am J Med 1987;82:220-223.
  58. Fridkin SK, Hageman JC, Morrison M, et al. Methicillinresistant Staphylococcus aureus disease in three communities. N Engl J Med 2005;352:1436-1444. https://doi.org/10.1056/NEJMoa043252
  59. Klevens RM, Morrison MA, Nadle J, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298:1763-1771. https://doi.org/10.1001/jama.298.15.1763
  60. Hasty MB, Klasner A, Kness S, et al. Cutaneous community-associated methicillin-resistant Staphylococcus aureus among all skin and soft-tissue infections in two geographically distant pediatric emergency departments. Acad Emerg Med 2007;14:35-40. https://doi.org/10.1111/j.1553-2712.2007.tb00368.x
  61. Moran GJ, Krishnadasan A, Gorwitz RJ, et al. Methicillinresistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355:666-674. https://doi.org/10.1056/NEJMoa055356
  62. Talan DA, Krishnadasan A, Gorwitz RJ, et al. Comparison of Staphylococcus aureus from skin and soft-tissue infections in US emergency department patients, 2004 and 2008. Clin Infect Dis 2011;53:144-149. https://doi.org/10.1093/cid/cir308
  63. Moran GJ, Amii RN, Abrahamian FM, Talan DA. Methicillin-resistant Staphylococcus aureus in communityacquired skin infections. Emerg infect Dis 2005;11:928-930. https://doi.org/10.3201/eid1106.040641
  64. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011; 52:e18-e55. https://doi.org/10.1093/cid/ciq146
  65. Kim ES, Song JS, Lee HJ, et al. A survey of communityassociated methicillin-resistant Staphylococcus aureus in Korea. J Antimicrob Chemother 2007;60:1108-1114. https://doi.org/10.1093/jac/dkm309
  66. Park JH, Byun JY, Lee DY, Lee JH, Yang JM, Lee ES. Trends of the bacterial skin infections of dermatology outpatients in 1996, 2001 and 2006. Korean J Dermatol 2009;47:690-695.
  67. Lee MW, Kim TH, Choo EJ, et al. Characteristics of necrotizing fasciitis in three university hospitals in Korea. Korean J Med 2006;70:681-687.
  68. Song SJ, Lee IS, Chung JH. Type I, II acute necrotizing fasciitis of the low extremity. J Korean Orthop Assoc 2007;42:636-643. https://doi.org/10.4055/jkoa.2007.42.5.636
  69. Bilton BD, Zibari GB, McMillan RW, Aultman DF, Dunn G, McDonald JC. Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study. Am Surg 1998;64:397-400.
  70. Dworkin MS, Westercamp MD, Park L, McIntyre A. The epidemiology of necrotizing fasciitis including factors associated with death and amputation. Epidemiol Infect 2009;137:1609-1614. https://doi.org/10.1017/S0950268809002532
  71. Khanna AK, Tiwary SK, Kumar P, Khanna R, Khanna A. A case series describing 118 patients with lower limb necrotizing fasciitis. Int J Low Extrem Wounds 2009;8: 112-116. https://doi.org/10.1177/1534734609334809
  72. Luca-Harari B, Ekelund K, van der Linden M, Staum- Kaltoft M, Hammerum AM, Jasir A. Clinical and epidemiological aspects of invasive Streptococcus pyogenes infections in Denmark during 2003 and 2004. J Clin Microbiol 2008;46: 79-86. https://doi.org/10.1128/JCM.01626-07
  73. Chelsom J, Halstensen A, Haga T, Hoiby EA. Necrotising fasciitis due to group A streptococci in western Norway: incidence and clinical features. Lancet 1994;344:1111-1115. https://doi.org/10.1016/S0140-6736(94)90629-7
  74. Lee CY, Kuo LT, Peng KT, Hsu WH, Huang TW, Chou YC. Prognostic factors and monomicrobial necrotizing fasciitis: gram-positive versus gram-negative pathogens. BMC Infect Dis 2011;11:5. https://doi.org/10.1186/1471-2334-11-5
  75. Childers BJ, Potyondy LD, Nachreiner R, et al. Necrotizing fasciitis: a fourteen-year retrospective study of 163 consecutive patients. Am Surg 2002;68:109-116.
  76. Brook I, Frazier EH. Clinical and microbiological features of necrotizing fasciitis. J Clin Microbiol 1995;33:2382-2387.
  77. Ward RG, Walsh MS. Necrotizing fasciitis: 10 years' experience in a district general hospital. Br J Surg 1991;78: 488-489. https://doi.org/10.1002/bjs.1800780431
  78. Giuliano A, Lewis F Jr, Hadley K, Blaisdell FW. Bacteriology of necrotizing fasciitis. Am J Surg 1977;134:52-57. https://doi.org/10.1016/0002-9610(77)90283-5
  79. Salcido RS. Necrotizing fasciitis: reviewing the causes and treatment strategies. Adv Skin Wound Care 2007;20:288-293. https://doi.org/10.1097/01.ASW.0000269317.76380.3b
  80. Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg 2009;208:279-288. https://doi.org/10.1016/j.jamcollsurg.2008.10.032
  81. McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 1995;221:558-563. https://doi.org/10.1097/00000658-199505000-00013
  82. Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am 2003; 85-A:1454-1460.
  83. Elliott D, Kufera JA, Myers RA. The microbiology of necrotizing soft tissue infections. Am J Surg 2000;179: 361-366. https://doi.org/10.1016/S0002-9610(00)00360-3
  84. Liu YM, Chi CY, Ho MW, et al. Microbiology and factors affecting mortality in necrotizing fasciitis. J Microbiol Immunol Infect 2005;38:430-435.
  85. Brothers TE, Tagge DU, Stutley JE, Conway WF, Del Schutte H Jr, Byrne TK. Magnetic resonance imaging differentiates between necrotizing and non-necrotizing fasciitis of the lower extremity. J Am Coll Surg 1998;187: 416-421. https://doi.org/10.1016/S1072-7515(98)00192-6
  86. Kim KT, Kim YJ, Lee JW, et al. Can necrotizing infectious fasciitis be differentiated from nonnecrotizing infectious fasciitis with MR imaging? Radiology 2011;259: 816-824. https://doi.org/10.1148/radiol.11101164
  87. Zacharias N, Velmahos GC, Salama A, et al. Diagnosis of necrotizing soft tissue infections by computed tomography. Arch Surg 2010;145:452-455. https://doi.org/10.1001/archsurg.2010.50
  88. Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (laboratory risk indicator for necrotizing fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004;32:1535-1541. https://doi.org/10.1097/01.CCM.0000129486.35458.7D
  89. Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis 2007;44:705-710. https://doi.org/10.1086/511638
  90. Mulla ZD, Leaverton PE, Wiersma ST. Invasive group A streptococcal infections in Florida. South Med J 2003;96: 968-973. https://doi.org/10.1097/01.SMJ.0000051060.95210.9A
  91. Stevens DL, Bryant AE, Hackett SP. Antibiotic effects on bacterial viability, toxin production, and host response. Clin Infect Dis 1995;20(Suppl 2):S154-S157. https://doi.org/10.1093/clinids/20.Supplement_2.S154
  92. Zimbelman J, Palmer A, Todd J. Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes infection. Pediatr Infect Dis J 1999;18:1096-1100. https://doi.org/10.1097/00006454-199912000-00014
  93. Chuang YC, Ko WC, Wang ST, et al. Minocycline and cefotaxime in the treatment of experimental murine Vibrio vulnificus infection. Antimicrob Agents Chemother 1998;42: 1319-1322.
  94. Chuang YC, Liu JW, Ko WC, Lin KY, Wu JJ, Huang KY. In vitro synergism between cefotaxime and minocycline against Vibrio vulnificus. Antimicrob Agents Chemother 1997;41: 2214-2217.
  95. Liu JW, Lee IK, Tang HJ, et al. Prognostic factors and antibiotics in Vibrio vulnificus septicemia. Arch Intern Med 2006;166:2117-2123. https://doi.org/10.1001/archinte.166.19.2117
  96. Tang HJ, Chang MC, Ko WC, Huang KY, Lee CL, Chuang YC. In vitro and in vivo activities of newer fluoroquinolones against Vibrio vulnificus. Antimicrob Agents Chemother 2002;46:3580-3584. https://doi.org/10.1128/AAC.46.11.3580-3584.2002
  97. Jallali N, Withey S, Butler PE. Hyperbaric oxygen as adjuvant therapy in the management of necrotizing fasciitis. Am J Surg 2005;189:462-466. https://doi.org/10.1016/j.amjsurg.2005.01.012
  98. Riseman JA, Zamboni WA, Curtis A, Graham DR, Konrad HR, Ross DS. Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements. Surgery 1990;108:847-850.
  99. Darenberg J, Ihendyane N, Sjolin J, et al. Intravenous immunoglobulin G therapy in streptococcal toxic shock syndrome: a European randomized, double-blind, Placebocontrolled trial. Clin Infect Dis 2003;37:333-340. https://doi.org/10.1086/376630
  100. Kaul R, McGeer A, Norrby-Teglund A, et al. Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome: a comparative observational study: the Canadian Streptococcal Study Group. Clin Infect Dis 1999;28:800-807. https://doi.org/10.1086/515199