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Cervical necrotizing fasciitis: 10 years' experience at a single institution
I Mohammedi1, P Ceruse, S Duperret
1Department of Intensive Care and Hyperbaric Medicine, Pavillon N, Edouard Herriot Hospital, Place d'Arsonval, F-69 003 Lyon, France. ismael.mohammedi@chu-lyon.fr
Intensive Care Medicine
|August 14, 1999
Summary
Prompt surgical débridement is critical for reducing mortality in patients with cervical necrotizing fasciitis. Early and aggressive intervention, including radical débridement and intensive care, improves outcomes for this severe head and neck infection.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Critical Care Medicine
Background:
- Cervical necrotizing fasciitis is a severe, rapidly progressing infection of the head and neck.
- Limited evidence-based guidelines exist for managing head and neck infections.
- This study examines clinical and microbiologic features, treatment, and outcomes.
Purpose of the Study:
- To evaluate clinical and microbiologic characteristics of cervical necrotizing fasciitis.
- To assess treatment modalities and patient outcomes.
- To identify factors influencing morbidity and mortality.
Main Methods:
- Retrospective clinical investigation.
- Review of 20 consecutive patients with cervical necrotizing fasciitis admitted to the Intensive Care Unit (1987-1998).
- Analysis of clinical data, microbiology, surgical procedures, and outcomes.
Main Results:
- All patients required mechanical ventilation; 4 had mediastinal involvement.
- Commonly implicated organisms included Streptococcus, Prevotella, and Peptostreptococcus species.
- Adequate surgical débridement correlated with better outcomes; 3 patients (15%) died.
Conclusions:
- Prompt surgical débridement is associated with decreased morbidity and mortality.
- Immediate radical débridement, potential re-débridement, antibiotics, and intensive care are crucial.
- A larger patient cohort is needed for definitive conclusions.