Cervical necrotizing fasciitis: 10 years' experience at a single institution.
OBJECTIVE
To evaluate clinical and microbiologic characteristics, modalities of treatment and outcome of patients with cervical necrotizing fasciitis admitted to our institution.


METHODS
Retrospective clinical investigation.


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.


CONCLUSIONS
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.
Mohammedi
I
I
Department of Intensive Care and Hyperbaric Medicine, Pavillon N, Edouard Herriot Hospital, Place d'Arsonval, F-69 003 Lyon, France. ismael.mohammedi@chu-lyon.fr
Ceruse
P
P
Duperret
S
S
Vedrinne
J
J
Boulétreau
P
P
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002176:Candida albicans / Q000302:isolation & purification; D002648:Child; D003646:Debridement; D019115:Fasciitis, Necrotizing / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009333:Neck; D018720:Prevotella / Q000302:isolation & purification; D012086:Reoperation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018461:Soft Tissue Infections / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013291:Streptococcus / Q000302:isolation & purification; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents