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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
Objective:
To evaluate clinical and microbiologic characteristics, modalities 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 hospitalized in our Intensive Care Unit between January 1987 and June 1998 with 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 Streptococcus, Prevotella, and Peptostreptococcus species. Patients with adequate surgery had a better outcome than those with inadequate surgical procedures. Because no evidence-based recommendations exist in the field of head 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 delayed, surgical débridement correlates with a decrease in morbidity and mortality. However, no definite conclusion is justified due to the relatively small number of patients. Immediate radical débridement, and early redébridement if needed, appropriate antibiotics and intensive care support are critical in controlling these life-threatening infections.