Cervical necrotizing fasciitis: 10 years' experience at a single institution

Objective: To evaluate clinical and microbiologic characteristics, modaliti es of treatment and outcome of patients with cervical necrotizing fasciitis admitted to our institution. Design: Retrospective clinical investigation. Patients and methods: We reviewed the charts of 20 consecutive patients hos pitalized in our Intensive Care Unit between January 1987 and June 1998 wit h the diagnosis of cervical necrotizing fasciitis. Results: All the patients required mechanical ventilation. Four of them had mediastinal involvement. The organisms most commonly implicated included S treptococcus, Prevotella, and Peptostreptococcus species. Patients with ade quate surgery had a better outcome than those with inadequate surgical proc edures. Because no evidence-based recommendations exist in the field of hea d and neck infections, hyperbaric oxygen was not used as adjunctive therapy . Of the 20 patients, 3 (15%) died. Conclusion: The main finding of this study is that prompt, rather than dela yed, surgical debridement correlates with a decrease in morbidity and morta lity. However, no definite conclusion is justified due to the relatively sm all number of patients. Immediate radical debridement, and early redebridem ent if needed, appropriate antibiotics and intensive care support are criti cal in controlling these life-threatening infections.