Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 3/2014

01-03-2014 | Original Article

Predictors of mortality for necrotizing soft-tissue infections: a retrospective analysis of 64 cases

Authors: Andreas Krieg, Levent Dizdar, Pablo Emilio Verde, Wolfram Trudo Knoefel

Published in: Langenbeck's Archives of Surgery | Issue 3/2014

Login to get access

Abstract

Purpose

Necrotizing soft-tissue infection (NSTI) is a rare, but rapidly progressive and life-threatening disease with a high morbidity and mortality. The aim of the present study was to evaluate predictors of mortality in a group of patients with NSTIs treated at a single center.

Methods

The medical records of all patients that were treated because of a NSTI at our department between 1996 and 2011 were retrospectively analyzed. To identify factors that were associated with patients’ outcome variables including demographic, clinical, laboratory, and microbiologic parameters were compared between the group of survivors and non-survivors.

Results

Sixty-four patients with the diagnosis of a NSTI were identified. The overall mortality was 32.8 %. Multiple regression analyses identified the development of a renal failure during the hospital stay and more importantly, the presence of visible skin necrosis on the initial clinical examination as independent prognostic markers for NSTIs.

Conclusion

In patients with NSTIs, skin necrosis may serve as an indicator for an advanced stage of the disease. Thus, the presence of visible skin necrosis as an independent predictor of mortality emphasizes the outstanding importance of early diagnosis and prompt treatment to improve the prognosis of patients with NSTIs.
Literature
1.
Jones J (1871) Surgical memoirs of the war of the rebellion: investigation upon the nature, causes, and treatment of hospital gangrene as prevailed in the confederate armies 1861-1865. US Sanitary Commission, New York
2.
Elliott DC, Kufera JA, Myers RA (1996) Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg 224:672–683
3.
McHenry CR, Piotrowski JJ, Petrinic D et al (1995) Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 221:558–563, discussion 563-555PubMedCentralPubMedCrossRef
4.
5.
Krieg A, Rohrborn A, Schulte Am Esch J et al (2009) Necrotizing fasciitis: microbiological characteristics and predictors of postoperative outcome. Eur J Med Res 14:30–36PubMedCentralPubMedCrossRef
6.
Singh G, Sinha SK, Adhikary S et al (2002) Necrotising infections of soft tissues—a clinical profile. Eur J Surg 168:366–371
7.
Shimizu T, Tokuda Y (2010) Necrotizing fasciitis. Intern Med 49:1051–1057
8.
9.
Chen JL, Fullerton KE, Flynn NM (2001) Necrotizing fasciitis associated with injection drug use. Clin Infect Dis 33:6–15
10.
Morgan MS (2010) Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect 75:249–257
11.
Anaya DA, Bulger EM, Kwon YS et al (2009) Predicting death in necrotizing soft tissue infections: a clinical score. Surg Infect (Larchmt) 10:517–522
12.
Huang KF, Hung MH, Lin YS et al (2011) Independent predictors of mortality for necrotizing fasciitis: a retrospective analysis in a single institution. J Trauma 71:467–473; discussion 473
13.
Bellomo R, Ronco C, Kellum JA et al (2004) Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204–R212
14.
15.
Ryssel H, Germann G, Kloeters O et al (2010) Necrotizing fasciitis of the extremities: 34 cases at a single centre over the past 5 years. Arch Orthop Trauma Surg 130:1515–1522
16.
17.
Golger A, Ching S, Goldsmith C et al (2007) Mortality in patients with necrotizing fasciitis. Plast Reconstr Surg 119:1803–1807PubMedCrossRef
18.
Boyer A, Vargas F, Coste F et al (2009) Influence of surgical treatment timing on mortality from necrotizing soft tissue infections requiring intensive care management. Intensive Care Med 35:847–853PubMedCrossRef
19.
Heitmann C, Pelzer M, Bickert B et al (2001) Surgical concepts and results in necrotizing fasciitis. Chirurg 72:168–173PubMedCrossRef
20.
Martinschek A, Evers B, Lampl L et al (2012) Prognostic aspects, survival rate, and predisposing risk factors in patients with Fournier’s gangrene and necrotizing soft tissue infections: evaluation of clinical outcome of 55 patients. Urol Int 89:173–179
21.
Tsitsilonis S, Druschel C, Wichlas F et al (2013) Necrotizing fasciitis: is the bacterial spectrum changing? Langenbecks Arch Surg 398:153–159
22.
Anaya DA, Mcmahon K, Nathens AB et al (2005) Predictors of mortality and limb loss in necrotizing soft tissue infections. Arch Surg 140:151–157, discussion 158PubMedCrossRef
23.
Yanar H, Taviloglu K, Ertekin C et al (2006) Fournier’s gangrene: risk factors and strategies for management. World J Surg 30:1750–1754PubMedCrossRef
24.
Hong YC, Chou MH, Liu EH et al (2009) The effect of prolonged ED stay on outcome in patients with necrotizing fasciitis. Am J Emerg Med 27:385–390PubMedCrossRef
25.
Bair MJ, Chi H, Wang WS et al (2009) Necrotizing fasciitis in southeast Taiwan: clinical features, microbiology, and prognosis. Int J Infect Dis 13:255–260PubMedCrossRef
26.
Bakleh M, Wold LE, Mandrekar JN et al (2005) Correlation of histopathologic findings with clinical outcome in necrotizing fasciitis. Clin Infect Dis 40:410–414PubMedCrossRef
27.
Bone RC, Balk RA, Cerra FB et al (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655PubMedCrossRef
28.
Wong CH, Chang HC, Pasupathy S et al (2003) Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am 85-A:1454–1460PubMed
29.
Lee TC, Carrick MM, Scott BG et al (2007) Incidence and clinical characteristics of methicillin-resistant Staphylococcus aureus necrotizing fasciitis in a large urban hospital. Am J Surg 194:809–812, discussion 812-803PubMedCrossRef
30.
Sarani B, Strong M, Pascual J et al (2009) Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg 208:279–288PubMedCrossRef
31.
Wang YS, Wong CH, Tay YK (2007) Staging of necrotizing fasciitis based on the evolving cutaneous features. Int J Dermatol 46:1036–1041PubMedCrossRef
32.
Frazee BW, Fee C, Lynn J et al (2008) Community-acquired necrotizing soft tissue infections: a review of 122 cases presenting to a single emergency department over 12 years. J Emerg Med 34:139–146PubMedCrossRef
33.
Wall DB, Klein SR, Black S et al (2000) A simple model to help distinguish necrotizing fasciitis from nonnecrotizing soft tissue infection. J Am Coll Surg 191:227–231PubMedCrossRef
34.
Callahan TE, Schecter WP, Horn JK (1998) Necrotizing soft tissue infection masquerading as cutaneous abcess following illicit drug injection. Arch Surg 133:812–817, discussion 817-819PubMedCrossRef
35.
Kobayashi L, Konstantinidis A, Shackelford S et al (2011) Necrotizing soft tissue infections: delayed surgical treatment is associated with increased number of surgical debridements and morbidity. J Trauma 71:1400–1405
36.
Hassan Z, Mullins RF, Friedman BC et al (2010) Treating necrotizing fasciitis with or without hyperbaric oxygen therapy. Undersea Hyperb Med 37:115–123
37.
George ME, Rueth NM, Skarda DE et al (2009) Hyperbaric oxygen does not improve outcome in patients with necrotizing soft tissue infection. Surg Infect (Larchmt) 10:21–28
38.
Wilkinson D, Doolette D (2004) Hyperbaric oxygen treatment and survival from necrotizing soft tissue infection. Arch Surg 139:1339–1345PubMedCrossRef
39.
Brown DR, Davis NL, Lepawsky M et al (1994) A multicenter review of the treatment of major truncal necrotizing infections with and without hyperbaric oxygen therapy. Am J Surg 167:485–489
Metadata
Title
Predictors of mortality for necrotizing soft-tissue infections: a retrospective analysis of 64 cases
Authors
Andreas Krieg
Levent Dizdar
Pablo Emilio Verde
Wolfram Trudo Knoefel
Publication date
01-03-2014
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 3/2014
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-014-1162-1

Other articles of this Issue 3/2014

Langenbeck's Archives of Surgery 3/2014 Go to the issue

Review Article

Selecting and measuring optimal outcomes for randomised controlled trials in surgery

Review Article

Insights into surgical trials: methodological challenges and solutions

Review Article

Approaches to assessing the benefits and harms of medical devices for application in surgery

Abstracts

131st Congress of the German Society for Surgery

Original Article

Intraoperative adverse events during laparoscopic colorectal resection—better laparoscopic treatment but unchanged incidence. Lessons learnt from a Swiss multi-institutional analysis of 3,928 patients

Original Article

Future perspectives for surgical research in Germany