title: Necrotizing soft tissue infections developing from pressure ulcers.
abstract: OBJECTIVE
  Necrotizing soft tissue infections (STIs) are serious complications that may arise from pressure ulcers. However, there are few studies on this important issue. In addition, diagnostic criteria for necrotizing STIs developing from pressure ulcers and infected pressure ulcers are not well established.
  
  
  METHODS
  We defined necrotizing STIs developing from pressure ulcers based on clinical findings. Based on the definition, we retrospectively analyzed the medical records of 24 elderly patients with this condition to determine patient age, gender, comorbid disease, laboratory findings, wound location, bacteriology, and treatment outcomes.
  
  
  RESULTS
  In the examined population, necrotizing STIs developed primarily from pressure ulcers over the sacrum. Dementia and diabetes mellitus were also frequently observed in patients with necrotizing STIs. The average Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was relatively low. Bacterial cultures from the debrided deep tissues exhibited mixed infections of gram-positive cocci and gram-negative bacilli, except 1 case. Anaerobic pathogens were isolated from 18 patients (72%), and 7 patients (29%) developed bacteremia. None of the cases were preceded by wounds dominated by granulation tissue. Surgical intervention, combined with antibacterial therapy involving intravenous carbapenem or cephem, was successfully used in most cases.
  
  
  CONCLUSIONS
  Necrotizing STIs arising from pressure ulcers are generally caused by mixed pathogens and exhibit symptoms that are milder than those of necrotizing fasciitis caused by group A Streptococcus.
authors.affiliation: Department of Pharmacy, National Center for Geriatrics and Gerontology, Japan.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Mizokami
authors.affiliation: Department of Pharmacy, National Center for Geriatrics and Gerontology, Japan; Department of Clinical Research and Development, National Center for Geriatrics and Gerontology, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Furuta
authors.affiliation: Division of Dermatology and Connective Tissue Medicine, Department of Advanced Medicine, National Center for Geriatrics and Gerontology, Japan. Electronic address: zenzo@ncgg.go.jp.
authors.forename: Zenzo
authors.initials: Z
authors.lastname: Isogai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D009336:Necrosis; D003668:Pressure Ulcer / Q000150:complications* / Q000473:pathology; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000209:etiology* / Q000473:pathology
keywords: Bacteremia; Necrotizing fasciitis; Pressure ulcer; Soft tissue infection