[Necrotizing fasciitis].
BACKGROUND
Necrotizing fasciitis (NF) is an acute soft-tissue infection, associated with a high mortality and morbidity. To reduce the mortality, an early diagnosis and treatment is essential. Our study aims to identify the number of patients, the microorganisms involved, and NF treatment outcomes among patients admitted to our unit.


METHODS
This retrospective cohort study enrolled 85 patients admitted to the multidisciplinary, tertiary Intensive Care Unit, Abdominal Center, Rigshospitalet, Denmark in 2005-2007. All received the same protocolled treatment of intensive care, extensive surgical débridements, broad-spectrum antibiotics, intravenous immunoglobulin and hyperbaric oxygen.


RESULTS
The microbiological analyses of specimens demonstrated that 51% were positive for polymicrobial infection, 40% for a single pathogen, 74% of these caused by beta-hemolytic streptococci, and 9% of the analyses were inconclusive. Of the patients, 91% required treatment in a respirator, 67.5% presented with septic shock and 25.3% developed acute renal failure needing dialysis. Intensive care unit mortality was 6% and 30-day mortality was 9.5%. Expected mortality based on SAPS II and APACHE II scoring was 38%. Our patients had a significantly higher body mass index than other patients admitted to the unit.


CONCLUSIONS
NF is a complex disease, often associated with multi-organ failure. A protocolled treatment plan with close cooperation between the intensive care, clinical microbiology, medical and surgical specialties seems to reduce mortality considerably in this vulnerable group of patients.
Rigshospitalet, Intensiv Terapiklinik, Afsnit 4131, Denmark. skovsen@dadlnet.dk
Anders Peter
AP
Skovsen
Jan
J
Bonde
Jakob Steen
JS
Andersen
Erik C
EC
Jansen
Michael
M
Tvede
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002985:Clinical Protocols; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D003646:Debridement; D019115:Fasciitis, Necrotizing / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D006931:Hyperbaric Oxygenation; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
D000900:Anti-Bacterial Agents; D016756:Immunoglobulins, Intravenous