title: Ten years of treating necrotizing fasciitis.
abstract: BACKGROUND
  Necrotizing fasciitis is a soft tissue infection characterized by rapid progression and a high mortality rate. The objective of this study was to investigate diagnosis, causative microbial agents, comorbidities, antibiotic regimen and outcome regarding this disease at Skåne University Hospital in Malmö, Sweden.
  
  
  METHODS
  From medical records, we identified 33 patients treated from January 2003 to January 2013, 31 of whom could be included in our investigation.
  
  
  RESULTS
  The infections were monomicrobial in 87% of the cases, and most were caused by group A streptococci. The rate of polymicrobial infections was lower than in other studies. In addition to blood and wound cultures, a rapid antigen detection test for group A streptococci was used in a majority of the cases as a supplement to other diagnostic tools. The time from onset of symptoms to surgery proved to be significantly shorter for patients infected with group A streptococci than for other patients. The mortality rate among all patients was 19%, which is lower than much of the historical material but in line with some more recent studies of this disease.
  
  
  CONCLUSIONS
  Our results indicate that low mortality rates can be achieved by surgery, appropriate antibiotics and good supportive care. Furthermore, we show that the use of the rapid antigen detection test for group A streptococci, in this setting, helps to shorten the time to surgical intervention in patients suffering from necrotizing fasciitis. This also helps to guide the antibiotic treatment into a narrower spectrum.
authors.affiliation: From the Department of Clinical Sciences, Lund University, Division of Infectious Diseases , Malmö , Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Nordqvist
authors.forename: Axel
authors.initials: A
authors.lastname: Walldén
authors.forename: Håkan
authors.initials: H
authors.lastname: Brorson
authors.forename: Johan
authors.initials: J
authors.lastname: Tham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D019115:Fasciitis, Necrotizing / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000401:mortality; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000401:mortality; D013297:Streptococcus pyogenes / Q000276:immunology* / Q000302:isolation & purification; D013548:Sweden / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Group A streptococcus; Streptococcus pyogenes; necrotizing fasciitis; necrotizing soft tissue infections; rapid antigen detection test