Implications of Risk Factors in Necrotizing Fasciitis

The following risk factors, previously associated with necrotizing fasciitis, were identified in 25 consecutive patients: diabetes mellitus, intravenous drug abuse, age greater than 50, hypertension, and malnutrition/obesity. Additional data recorded included the duration of illness to the time of the first operative procedure, the type of procedure performed, the anatomic location of the infection, the etiology, culture reports, and leukocyte counts. The goal of this study was to determine whether the number of risk factors present in a patient was predictive of mortality. Six patients (24%) died and 19 patients survived. The nonsurvivors exhibited a significantly higher percentage of diabetes mellitus, 83 per cent versus 37 per cent (P = 0.047). Fifteen of 19 survivors (79%) and only one of six nonsurvivors (17%) had fewer than three risk factors (P = 0.006). In conclusion, more than three previously identified risk factors present in patients with necrotizing fasciitis were found to be predictive of a mortality rate of 50 per cent. The mainstay of treatment remains aggressive surgical intervention, broad-spectrum antibiotics, and nutrition support.