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Outcomes and Predictors of Fungal Necrotizing Soft Tissue Infections
Courtney Collins1, Bradley Butsch1, Mohammed Choudhary1
1Department of Surgery, Division of Trauma, Critical Care, and Burn Surgery, Center for Translational Research in ACS, Critical Care, and Trauma (CTRACT), The Ohio State University, Columbus, Ohio, USA.
Surgical Infections
|May 28, 2026
Summary
Fungal necrotizing soft tissue infections (NSTIs) are often diagnosed late, leading to worse outcomes. Early antifungal therapy in high-risk patients, especially those with diabetes, may improve management of these fungal infections.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Mycology
Background:
- Fungal necrotizing soft tissue infections (NSTIs) are frequently diagnosed late, contributing to poor patient outcomes.
- Traditional management focuses on bacterial infections and surgical debridement, often delaying antifungal treatment.
Purpose of the Study:
- To identify predictors, treatment patterns, and outcomes associated with fungal NSTIs.
- To improve the diagnosis and management of fungal infections in NSTIs.
Main Methods:
- Retrospective review of 634 patients with NSTIs from 2011 to 2023.
- Stratification of patients based on fungal presence in wound cultures.
- Logistic regression analysis to determine predictors of fungal infection.
Main Results:
- Fungal-positive cultures were found in 17.4% of patients, with Candida albicans being most common.
- Fungal NSTIs were associated with higher rates of diabetes mellitus, ≥ 3 debridements, longer hospital stays, mechanical ventilation, and increased 90-day mortality.
- Predictors of fungal infection included female gender, diabetes mellitus, vasopressor use, and VRE infection.
Conclusions:
- Fungal NSTIs are linked to significantly worse patient outcomes.
- Consideration of early empirical antifungal therapy in high-risk individuals, particularly those with diabetes, is recommended.
- This approach should be integrated into comprehensive NSTI management strategies.
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