Severe necrotizing soft-tissue infections and nonsteroidal anti-inflammatory drugs
Abstract
BACKGROUND: Severe necrotizing soft-tissue infection (NSTI) is a rare but potentially life-threatening condition if not recognized and treated early. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been implicated as a contributing factor, but their role remains debated. AIMS: The aim of our study was to investigate the potential relationship between cases of NSTI recorded in the French Pharmacovigilance system and exposure to NSAIDs. METHODS: Cases of NSTI and randomly selected matched noncase controls (without skin disease) were identified in the database of the Spontaneous Reporting System in France for the period 2000-2004. Exposure to NSAIDs and other factors were investigated using conditional logistic regression. RESULTS: We found 38 cases of NSTI in 2000-04: 12 infants (0-23 months), 16 children (2-15 years) and 10 adults (>15 years), and we selected 228 controls. The median age of the sample was 4 years. Of the 38 cases, 25 were exposed to ibuprofen and 24 presented with varicella. The adjusted odds ratio for exposure to NSAIDs was 31.38 (95% CI 6.40-153.84), and 17.55 (95% CI 3.47-88.65) for viral infection. Other predisposing factors (diabetes, immunosuppression, injecting drugs) were not found to be associated, although this may have been due to the very small number of cases of NSTI/necrotizing fasciitis in adults reported in the database. CONCLUSION: Despite the limitations related to a spontaneous reporting system, this study indicates a strong association between NSAID use and NSTI. Although it was not possible to conclude if NSAIDs increase the risk of necrotizing complications in all patients, their use may mask the symptoms and delay diagnosis.
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The inference that acute inflammation usually has positive effects is strongly supported by findings that inhibiting the inflammatory response by nonsteroidal anti-inflammatory drugs worsens wound and bone healing, increases the risk of anastomotic failure or sepsis after surgery, aggravates heart and renal failure, interferes with an adequate immune response to antigen presentation in the gut, or
“The inference that acute inflammation usually has positive effects is strongly supported by the finding that inhibiting the inflammatory response by nonsteroidal anti‐inflammatory drugs worsens wound and bone healing,47, 48, 49, 50 increases the risk of anastomotic failure or sepsis after surgery,51, 52 aggravates heart and renal failure,53, 54 interferes with an adequate immune response to”
From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [48]
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Hypoalbuminemia: Pathogenesis and Clinical Significance
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- Authors
- Souyri, C., Olivier, P., Grolleau, S., Lapeyre-Mestre, M., & the French Network of Pharmacovigilance Centres
- Affiliations
- Centre Hospitalier Universitaire de Toulouse (FR)
- ORCID
- Olivier, P.
- Venue
- Clinical and Experimental Dermatology
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-05
- Volume
- 33
- Issue
- 3
- Pages
- 249-255
- ISSN
- 0307-6938 (ISSN-L)
- 1365-2230
- OpenAlex
- W2011317578
- Cited by
- 128
- References
- 19
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 11 · 2023: 2 · 2022: 25 · 2021: 8 · 2020: 5 · 2019: 6 · 2018: 6 · 2017: 7 · 2016: 4 · 2015: 7 · 2014: 12 · 2013: 5 · 2012: 5
- FWCI
- 6.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical and Experimental Dermatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Health Sciences › Medicine › Infectious Diseases › Otolaryngology and Infectious Diseases
- Keywords
- necrotizing soft tissue infection, necrotizing fasciitis, nonsteroidal anti-inflammatory drugs, ibuprofen, varicella, spontaneous reporting systems, pharmacovigilance, delayed diagnosis, infants and children
- MeSH terms
- Adolescent, Adult, Aged, Anti-Inflammatory Agents, Non-Steroidal, Chickenpox, Child, Child, Preschool, Fascia, Female, France, Humans, Infant, Male, Middle Aged, Pseudomonas Infections, Staphylococcal Infections, Case-Control Studies, Treatment Outcome, Adverse Drug Reaction Reporting Systems, Soft Tissue Infections, Fasciitis, Necrotizing
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