Keck Medicine of USC is taking yet another step to care for patients most in need of expert physicians, as the Department of Surgery has formed a program to accept patients who require complex treatment.

“The USC Acute Care Surgery program is one of the largest and busiest in the United States, and includes surgeons with a high level of training in treating necrotizing soft-tissue infections, or NSTI, as well as complications from abdominal operations known as enteric fistulas,” said Demetrios Demetriades, MD, PhD, professor of surgery at the Keck School of Medicine of USC and chief of the trauma and critical care division.

Keck Medicine’s unique ability to deal with these challenging cases has inspired the Department of Surgery to form a unified program called NecSTEP that accepts patients with enteric fistulas and other post-operative abdominal complications from California and other states, and will take NSTI cases from across Southern California. Medical personnel will be able to call a dedicated number, talk directly to an attending surgeon on the team, and arrange for fast transfer.

In NSTI cases, the infection spreads quickly, with bacteria eating the patient’s skin and connective tissue, causing severe damage, organ failure and, often, death. Patients with NSTI require immediate treatment by an expert multidisciplinary team; those who survive the infection will need numerous operations and an extended hospital stay, he said.

Demetriades has lectured nationally and internationally and has published numerous scientific studies on the treatment of NSTI. Under his leadership, the team has developed an aggressive and successful approach. The reported mortality for NSTI is 15 percent to 30 percent, but the rate for NSTI cases at USC is less than 5 percent.

“The difference comes down to physician experience,” Demetriades said. “These cases are exceedingly rare. Most physicians have never seen this disease and their experience with the diagnosis, treatment and complications is minimal. At USC, we have amassed a broad experience as an NSTI treatment and referral center.”

Enteric fistulas also are associated with a high mortality rate. These complications occur following abdominal operations or severe inflammation of the abdominal lining. Management of the condition can challenge the skills of even the most experienced surgeons.

“Keeping these patients stable and then getting them healthy and back to their regular lives requires a series of meticulous staged operations and an experienced multi-disciplinary team,” explained Kenji Inaba, MD, associate professor of surgery (clinical scholar) at the Keck School, vice chair of the Department of Surgery and director of the general surgery program. The USC program has such a stellar reputation in the treatment of enteric fistulas that patients are frequently referred from out of state, he added.

Demetriades believes the program is a major step in patient care.

“With fast action and an experienced multidisciplinary team, we will be able to give people the best possible outcomes,” Demetriades said.

— Lex Davis