IMPLICATIONS OF RISK-FACTORS IN NECROTIZING FASCIITIS

The following risk factors, previously associated with necrotizing fas ciitis, were identified in 25 consecutive patients: diabetes mellitus, intravenous drug abuse, age greater than 50, hypertension, and malnut rition/obesity. Additional data recorded included the duration of illn ess to the time of the first operative procedure, the type of procedur e performed, the anatomic location of the infection, the etiology, cul ture reports, and leukocyte counts. The goal of this study was to dete rmine whether the number of risk factors present in a patient was pred ictive of mortality. Six patients (24%) died and 19 patients survived. The nonsurvivors exhibited a significantly higher percentage of diabe tes mellitus, 83 per cent versus 37 per cent (P = 0.047). Fifteen of 1 9 survivors (79%) and only one of six nonsurvivors (17%) had fewer tha n three risk factors (P = 0.006). In conclusion, more than three previ ously identified risk factors present in patients with necrotizing fas ciitis were found to be predictive of a mortality rate of 50 per cent. The mainstay of treatment remains aggressive surgical intervention, b road-spectrum antibiotics, and nutrition support.