Research Information System
The 7th Eurasia Congress of Infectious Diseases, Tiflis, Georgia, 30 September - 03 October 2015, vol.3, pp.81, (Full Text)
INTRODUCTION: Injectional soft tissue infection is a serious problem in general medical practice. Non steroid anti-inflammatory
drug (NSAID) injection is extensively used in outpatient’s clinic. The complications after intramuscular injection have been recorded
as 0.4 to 19.3%. One of the most common complications is the infections including tissue necrosis and abscess formation.
Inoculates of microorganisms via injector from skin flora or contaminated drug may lead to infection. The risk of deep soft tissue
infections increases in immunosuppressive patients. Herein, the clinical and therapeutic features and outcome of nine cases having
intramuscular injection history, with severe soft tissue infections or fasciitis, are presented.
METHOD: The patients’ files reviewed between January 2013 and March 2015 retrospectively. Predisposing factors, demographic
characteristics, co-morbid conditions and injection history were recorded. Clinical and laboratory findings and outcome were
analyzed.
RESULTS: Nine cases were recorded. Five were male and the median age was 51 year. Seven of them have the history of NSAID
injection. The most common NSAID was diclofenac sodium, and comorbid condition was diabetes mellitus. Median time for severe
soft tissue infection development was 5.8 days. Extensive inflammation of the drug injected extremity in 7 cases and severe sepsis
in 6 and septic shock in 4 were observed. Surgical debridement was carried out in 7 patients. Morphologically mixed bacteria were
seen in Gram stain. Methicillin-sensitive "Staphylococcus aureus" was isolated in two patients. Other 3 patients, "Streptococcus
bovis", Salmonella Typhi and an anaerobic microorganism were isolated respectively. Extensive inflammation and tissue necrosis
were seen in tissue biopsies of 3 patients. Laboratory risk indicator for necrotizing fasciitis (LRINECC) scoring was high grade in 5
patients. Two of 9 patients died (22%).
CONCLUSION: Intramuscular NSAIDs injection may lead a severe soft tissue infection and severe sepsis in community. Sometimes,
the infection may lead to death. It seems that the mostly responsible NSAIDs are diclofenac sodium. Further studies are needed to
clarify the role of NSAIDs.