title: Local variations in the epidemiology, microbiology, and outcome of necrotizing soft-tissue infections: a multicenter study.
abstract: BACKGROUND
  Necrotizing soft-tissue infections (NSTIs) are rare and highly lethal.
  
  
  METHODS
  A retrospective chart review of patients with NSTIs treated at 6 academic hospitals in Texas between January 1, 2004 and December 31, 2007. Patient demographics, presentation, microbiology, treatment, and outcome were recorded. Analysis of variance, chi-square test, and logistic regression analysis were performed.
  
  
  RESULTS
  Mortality rates varied between hospitals from 9% to 25% (n = 296). There was significant interhospital variation in patient characteristics, microbiology, and etiology of NSTIs. Despite hospital differences in treatment, primarily in critical care interventions, patient age and severity of disease (reflected by shock requiring vasopressors and renal failure postoperatively) were the main predictors of mortality.
  
  
  CONCLUSIONS
  Significant center differences occur in patient populations, etiology, and microbiology of NSTIs, even within a concentrated region. Management should be based on these characteristics given that adjunctive treatments are unproven and variations in outcome are likely because of patient disease at presentation.
authors.affiliation: Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA. Lillian.S.Kao@uth.tmc.edu
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
authors.forename: Debbie F
authors.initials: DF
authors.lastname: Lew
authors.forename: Samer N
authors.initials: SN
authors.lastname: Arab
authors.forename: S Rob
authors.initials: SR
authors.lastname: Todd
authors.forename: Samir S
authors.initials: SS
authors.lastname: Awad
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Carrick
authors.forename: Michael G
authors.initials: MG
authors.lastname: Corneille
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003422:Critical Care; D019115:Fasciitis, Necrotizing / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D009336:Necrosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018461:Soft Tissue Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome