title: Early diagnosis and treatment of necrotizing fasciitis can improve survival: an observational intensive care unit cohort study.
abstract: BACKGROUND
  The aim of this study was to describe the clinical characteristics, causative pathogens, clinical management and outcomes of patients presenting to a tertiary adult Australian intensive care unit (ICU) with a diagnosis of necrotizing fasciitis (NF).
  
  
  METHODS
  This retrospective observational study was conducted in a 19-bed, level III, adult ICU in a 450-bed tertiary, regional hospital. Clinical databases were accessed for patients diagnosed with NF and admitted to The Geelong Hospital ICU between 1 February 2000 and 1 June 2011. Information on severity of sepsis, surgical procedures and microbiological results were collected.
  
  
  RESULTS
  Twenty patients with NF were identified. The median age was 52.5 years and 38% were female. The overall mortality rate was 8.3%. Common co-morbidities were diabetes (21%) and heart failure (17%), although 50% of patients had no co-morbidities. Group A Streptococcus was the identified pathogen in 11 (46%) patients, and Streptococcus milleri group in 5 (21%) patients. Hyperbaric oxygen therapy was not used in the majority of patients. The initial antibiotics administered were active against subsequently cultured bacteria in 83% of patients. Median time to surgical debridement was 20 h. Diagnosis and management was delayed in the nosocomial group.
  
  
  CONCLUSIONS
  This study reports physiological data, aetiology and therapeutic interventions in NF for an adult tertiary hospital. We demonstrate one of the lowest reported mortality rates, with early surgical debridement being achieved in the majority of patients. The main delay was found to be in the diagnosis of NF.
authors.affiliation: Department of Anaesthetics, The Geelong Hospital, Geelong, Victoria, Australia. kellybucca@gmail.com
authors.forename: Kelly
authors.initials: K
authors.lastname: Bucca
authors.forename: Ryan
authors.initials: R
authors.lastname: Spencer
authors.forename: Neil
authors.initials: N
authors.lastname: Orford
authors.forename: Claire
authors.initials: C
authors.lastname: Cattigan
authors.forename: Eugene
authors.initials: E
authors.lastname: Athan
authors.forename: Anthony
authors.initials: A
authors.lastname: McDonald
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003428:Cross Infection / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D003646:Debridement; D042241:Early Diagnosis; D004756:Enterobacteriaceae Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D006931:Hyperbaric Oxygenation; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D020613:Morganella morganii / Q000302:isolation & purification; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D034364:Streptococcus milleri Group / Q000302:isolation & purification; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents