NECROTIZING SOFT-TISSUE INFECTIONS - RISK-FACTORS FOR MORTALITY AND STRATEGIES FOR MANAGEMENT

Objective The authors evaluate in a retrospective fashion the factors influencing outcome in a large group of patients presenting with necro tizing soft tissue infections, and, based on this analysis, propose a plan for optimal care of such patients. Summary Background Data In man y smaller series of patients with necrotizing soft tissue infections, similar analyses of risk factors for mortality have been performed, pr oducing conflicting conclusions regarding optimal care. In particular, debate exists regarding the impact of concurrent physiologic derangem ents, type and extent of infection, and the role of hyperbaric oxygen in treatment. Methods A retrospective chart review of 198 consecutive patients with documented necrotizing soft tissue infections, treated a l a single institution during an 8-year period, was conducted. Using a model far logistic regression analysis, characteristics of each patie nt and his/her clinical course were tested for impact on outcome. Resu lts The mortality rate among the 198 patients was 25.3%. The most comm on sites of origin of infection were the perineum (Fournier's disease; 36% of cases) and the foot (in diabetics; 15.2%). By logistic regress ion analysis, risk factors for death included age, female gender, exte nt of infection, delay in first debridement, elevated serum creatinine level, elevated blood lactate level, and degree of organ system dysfu nction at admission. Diabetes mellitus did not predispose patients to death, except in conjunction with renal dysfunction or peripheral vasc ular disease. Myonecrosis, noted in 41.4% of the patients who underwen t surgery, did not influence mortality. Conclusions Necrotizing soft t issue infections represent a group of highly lethal infections best tr eated by early and repeated extensive debridement and broad-spectrum a ntibiotics. Hyperbaric oxygen appears to offer the advantage of early wound closure. Certain markers predict those individuals at increased risk for multiple-organ failure and death and therefore assist in deci ding allocation of intensive care resources.