Cervical necrotizing fasciitis: clinical manifestations and management.
Forty-five cases of cervical necrotizing fasciitis are reported, and their clinical, bacteriologic, and therapeutic implications are considered. Fasciitis was of dental origin in 78% of cases, pharyngeal in 16%, and surgical or posttraumatic in 6%. The condition extended to the face in 22% of cases, to the lower part of the neck in 56%, and to the mediastinum in 40%. Soft-tissue cultures were positive in 78% of cases. Anaerobes were isolated along with aerobes in 49% of cases (mean, 2.2 isolates per patient) and in pure culture in 22%. Treatment included surgical debridement and drainage and the administration of antibiotics active against both anaerobic and gram-negative aerobic bacteria. Hyperbaric oxygen was used for adjunctive treatment. The bacteria involved did not affect clinical manifestations, extension, or mortality. The survival rate among our patients was 78%. Mortality was significantly higher among cases with mediastinal extension (44% vs. 7%; P < .01); thus the prompt recognition and drainage of sites of mediastinal extension are of critical importance. Other risk factors for death were an age of > 70 years, underlying diabetes, the development of septic shock within 24 hours after admission, and prolonged prothrombin time.
Mathieu
D
D
Service d'Urgence Respiratoire, de Réanimation Médicale et de Médecine Hyperbare, Hôpital Albert Calmette, Lille, France.
Neviere
R
R
Teillon
C
C
Chagnon
J L
JL
Lebleu
N
N
Wattel
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001421:Bacteria, Anaerobic / Q000187:drug effects / Q000302:isolation & purification; D001424:Bacterial Infections / Q000382:microbiology* / Q000628:therapy*; D003646:Debridement; D004322:Drainage; D005208:Fasciitis / Q000209:etiology / Q000382:microbiology* / Q000628:therapy*; D005260:Female; D006088:Gram-Negative Aerobic Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009333:Neck; D009336:Necrosis; D010608:Pharyngeal Diseases / Q000150:complications / Q000382:microbiology / Q000628:therapy; D012307:Risk Factors; D014076:Tooth Diseases / Q000150:complications / Q000382:microbiology / Q000628:therapy
D000900:Anti-Bacterial Agents