NECROTIZING SOFT-TISSUE INFECTIONS

Objectives: To evaluate the causes of necrotizing soft tissue infectio ns (NSTIs) and to determine the outcomes of patients with NSTIs. Desig n: A restrospective survey of the causes and factors associated with t he outcomes. Setting: An urban community hospital serving an indigent population. Patients: A consecutive series of patients with NTSIs who were treated between December 11, 1990, and December 28, 1995. Interve ntions: Patients were treated with operative debridement, intravenous antibiotics, and supportive measures. Main Outcome Measures: Patient o utcomes, causes, the extent of infection, the health status of the pat ients, causative organisms, and treatment delays. Results: Forty-five patients with NSTIs were identified. Twenty-eight cases (62%) have occ urred since January 13, 1994. Parenteral drug abuse, the causative eve nt in 25 cases (56%), accounted for 21 (75%) of the 28 cases identifie d since January 13, 1994. Skin flora were the primary isolates in 18 ( 40%) of the eases; 78% of these flora were polymicrobial. Clostridial species were isolated in 8 (18%) of the cases. The overall mortality w as 27%. Survivors had less extensive infections and were more stable h emodynamically than nonsurvivors. Patients with necrosis and celluliti s greater than 250 cm(2) were less likely to survive than those with l ess extensive infections. Logistic regression analysis identified the extent of infection, the initial blood pressure, and the initial tempe rature as independent predictors of outcome in this patient series. Co nclusions: This is 1 of the largest reported series of patients with N STIs in which parenteral drug abuse is a prevalent causative factor. T he proportion of NSTIs attributable to the injection of illicit substa nces has increased notably in the past 2 years and has reached epidemi c proportions. Survivors of NSTIs had less extensive infections and we re more often hemodynamically stable than nonsurvivors. Clostridial sp ecies were common in patients with NSTIs related to parenteral drug ab use, underscoring the need for awareness of the potential for wound bo tulism in these patients.