title: Necrotizing soft tissue infections after injection therapy: Higher mortality and worse outcome compared to other entry mechanisms.
abstract: OBJECTIVE
  Necrotizing Soft Tissue Infections represent a rare entity of infection associated with a high mortality. The aim of this retrospective study was to analyze patients with an iatrogenic etiology of injection or infiltration to compare the outcome with other etiologies.
  
  
  METHODS
  The study group consisted of 21 patients treated with a Necrotizing Fasciitis caused by injection or infiltration. Risk factors and outcome were compared to 134 patients with a Necrotizing Fasciitis caused by other entry mechanisms.
  
  
  RESULTS
  Overall mortality in our study group was 14 of 21 (67%) with an amputation rate of 11 of 15 (73%) if an extremity was involved. The survival rate was significantly worse after injection or infiltration (p < 0.001) as was the amputation rate (p = 0.013), the percentage of patients requiring intensive care (100% vs. 83%, p = 0.038) and vasopressors (81% vs. 54%, p = 0.02). Injection or infiltration therapy proved to be the strongest prognostic factor (p = 0.003) besides the known risk factors obesity (0.007) and renal insufficiency (0.025).
  
  
  CONCLUSIONS
  Our results demonstrate that patients with a Necrotizing Soft Tissue Infection after injection or infiltration therapy have a significantly worse prognosis.
authors.affiliation: Trauma Center Murnau, Professor-Küntscherstr. 8, 82418 Murnau, Germany. Electronic address: Jan.Friederichs@bgu-murnau.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Friederichs
authors.affiliation: Trauma Center Murnau, Professor-Küntscherstr. 8, 82418 Murnau, Germany. Electronic address: Sebastian.Torka@bgu-murnau.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Torka
authors.affiliation: Trauma Center Murnau, Professor-Küntscherstr. 8, 82418 Murnau, Germany. Electronic address: Matthias.Militz@bgu-murnau.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Militz
authors.affiliation: Trauma Center Murnau, Professor-Küntscherstr. 8, 82418 Murnau, Germany. Electronic address: buehren@bgu-murnau.de.
authors.forename: Volker
authors.initials: V
authors.lastname: Bühren
authors.affiliation: Trauma Center Murnau, Professor-Küntscherstr. 8, 82418 Murnau, Germany. Electronic address: Sven.Hungerer@bgu-murnau.de.
authors.forename: Sven
authors.initials: S
authors.lastname: Hungerer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D019115:Fasciitis, Necrotizing / Q000209:etiology* / Q000382:microbiology / Q000401:mortality* / Q000628:therapy; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000209:etiology* / Q000382:microbiology / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Injection therapy; Necrotizing fasciitis; Necrotizing soft tissue infection