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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
PubMed
Abstract

Insights

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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