The epidemiology of necrotizing fasciitis including factors associated with death and amputation

• Published in: Epidemiology and infection 2009-11, Vol.137 (11), p.1609-1614
• Main Authors: DWORKIN, M. S., WESTERCAMP, M. D., PARK, L., McINTYRE, A.
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Amputation; Amputation - mortality; Antimicrobial agents; Bacterial infections; Biological and medical sciences; Chicago - epidemiology; Clostridium Infections - mortality; Comorbidity; Diabetes mellitus; Disease; Fasciitis, Necrotizing - complications; Fasciitis, Necrotizing - mortality; Fasciitis, Necrotizing - surgery; Fatalities; Female; Fundamental and applied biological sciences. Psychology; Hospitalization; Hospitals; Humans; Infections; Male; Medical prognosis; Medical records; Microbiology; Middle Aged; Mortality; Necrotizing fasciitis; Odds Ratio; Patients; Retrospective Studies; Risk Factors; Sepsis - complications; Sepsis - mortality; Sex Factors; Streptococcal Infections - mortality; streptococcus; Streptococcus pyogenes - isolation & purification
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S0950268809002532

The high morbidity and mortality of necrotizing fasciitis (NF) supports the need for epidemiological studies to characterize the disease and identify patient factors associated with adverse outcomes. A multi-site medical record review of patients diagnosed with NF was performed (n=80, mortality 15%). Variables collected were hypothesized to have association with adverse outcomes from NF, and multivariable analysis was used to detect any such association in this population. Select factors associated with mortality included evidence of underlying conditions (P=0·002), advanced age (P=0·04), young age (P=0·03), and evidence of sepsis (P=0·006). Select factors associated with amputation included diabetes mellitus (P=0·006), evidence of underlying conditions (P=0·03), and cutaneous gangrene noted on admission (P=0·006). These findings demonstrate the important association of NF and extremes of age with mortality and morbidity and support the value of early suspicion with prompt diagnosis and treatment in order to prevent adverse outcomes since the associated risk factors are not immediately modifiable.