title: Necrotizing fasciitis associated with injection drug use.
abstract: We studied cases of necrotizing fasciitis among injection drug users (IDUs) and non-IDUs who presented at the University of California Davis Medical Center from 1984 through 1999. Of 107 patients, 59 (55%) were IDUs and 48 (45%) non-IDUs. Among IDUs, 32 (54%) recently injected at the site of infection, and 17 patients (29%) presented with an abscess. Among non-IDUs, 17 (35%) reported a recent insect bite and 9 (19%) reported a wound or abrasion at the site of infection. Overall, seventy cases (65%) had > or = 3 debridements, and 31 patients (29%) had > 5% of their total body surface area debrided. Of all patients with necrotizing fasciitis, 16 (15%) did not survive. Among the 59 IDUs, 6 (10%) did not survive, while among non-IDUs, 10 (21%) did not survive. Our results indicate the need for a high index of suspicion for necrotizing fasciitis among patients presenting with cellulitis, a recent insect bite, wound, or recent injection drug use. Preventive interventions for necrotizing fasciitis among IDUs should include street-based education and treatment for abscesses and cellulitis.
authors.affiliation: Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, USA. jachen@dhs.co.la.ca.us
authors.forename: J L
authors.initials: JL
authors.lastname: Chen
authors.forename: K E
authors.initials: KE
authors.lastname: Fullerton
authors.forename: N M
authors.initials: NM
authors.lastname: Flynn
mesh_terms: D000328:Adult; D019115:Fasciitis, Necrotizing / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*