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[Necrotizing fasciitis].
Anders Peter Skovsen1, Jan Bonde, Jakob Steen Andersen
1Rigshospitalet, Intensiv Terapiklinik, Afsnit 4131, Denmark. skovsen@dadlnet.dk
Ugeskrift for Laeger
|February 12, 2010
Summary
Necrotizing fasciitis (NF) is a severe infection requiring prompt treatment. A multidisciplinary protocolled approach significantly reduced mortality in intensive care unit patients, despite high rates of septic shock and organ failure.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Surgical Infections
Background:
- Necrotizing fasciitis (NF) is a rapidly progressing soft-tissue infection with high mortality and morbidity.
- Early diagnosis and aggressive treatment are critical for improving patient outcomes.
- This study investigates patient demographics, causative microorganisms, and treatment results for NF.
Purpose of the Study:
- To determine the number of patients with necrotizing fasciitis admitted to the unit.
- To identify the microorganisms responsible for NF infections.
- To evaluate the treatment outcomes and mortality rates in NF patients.
Main Methods:
- A retrospective cohort study of 85 patients admitted to a multidisciplinary, tertiary Intensive Care Unit between 2005 and 2007.
- All patients received protocolled intensive care, surgical débridements, broad-spectrum antibiotics, intravenous immunoglobulin, and hyperbaric oxygen.
- Data collected included microbiological findings, clinical status, and mortality.
Main Results:
- Polymicrobial infections were found in 51% of cases, with beta-hemolytic streptococci being common in single-pathogen infections (74%).
- High rates of critical illness were observed: 91% required mechanical ventilation, 67.5% had septic shock, and 25.3% developed acute renal failure.
- Intensive care unit mortality was 6%, and 30-day mortality was 9.5%, significantly lower than the predicted mortality (38%).
- Patients exhibited a higher body mass index compared to other unit admissions.
Conclusions:
- Necrotizing fasciitis is a complex condition frequently leading to multi-organ failure.
- A coordinated, protocolled treatment strategy involving intensive care, microbiology, and surgical specialties can substantially decrease mortality in high-risk NF patients.
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