CLINICAL MANIFESTATIONS MICROBIOLOGY AND PROGNOSIS OF 42 PATIENTS WITH NECROTIZING FASCIITIS

Forty-two cases of necrotizing fasciitis (NF) surgically confirmed bet ween January 1991 and October 1995 were retrospectively reviewed. This was done in order to describe the underlying diseases, clinical prese ntations, etiology and outcome of NF and to assess the prognostic valu e of a simplified severity scoring system. The system scores changes i n consciousness status, body temperature, blood pressure and ventilati on to determine the likely outcome of NF. Twenty-five men and 17 women with a median age of 51 years (range, 17-87 yr) were included. Diabet es mellitus (57.1%) was the most common underlying disease. The mean d uration of symptoms before admission was 8 days (median, 7 d; range, 1 -30 d). The extremities (66.7%) were most commonly involved. Initial c linical presentations within 48 hours of admission included skin eryth ema and swelling at the affected site (97.6%), pyrexia (61.9%), hypote nsion (33.3%), altered consiousness (28.6%), bullous lesions (26.2%) a nd crepitus (9.5%). The mean number of isolated pathogens was 1.8 (ran ge, 0-6). Eight patients had mixed aerobic and anaerobic infections. T he attributable case fatality rate was 23.8%. Higher severity score (g reater than or equal to 4 points), hypotension, altered consiousness, respiratory failure requiring ventilator support, elevation of alanine aminotransferase levels > twofold, serum creatinine > 117 mu mol/L, t hrombocytopenia (< 100 x 10(9)/L), and worsening symptoms and signs wi thin 48 hours of admission were associated with higher fatality rates (p < 0.05).