Necrotizing fasciitis and non steroidal anti-inflammatory drugs: a case series and review of the literature.

AIMS

To assess two years experience of necrotizing fasciitis in the Department of Intensive Care Medicine (DICM), Middlemore Hospital, and to investigate a possible link with non steroidal antiinflammatory drugs (NSAID's).

METHODS

A retrospective chart review of patients with soft tissue infections admitted to the DICM between January 1998 and December 1999.

RESULTS

There were 24 cases of soft tissue infection, of which thirteen had necrotizing fasciitis. In the latter group, nine were diabetics, and three had elevated glycosylated haemoglobin. Seven were obese and twelve had two or more comorbities. Five were taking NSAID's. Wound swabs and/or tissue biopsies were positive in eleven patients, but only three had positive blood cultures. Mortality was 6/13 (46%). The seven survivors had a mean of 5.7 operations and a mean hospital stay of 39 days.

CONCLUSIONS

The literature contains scattered anecdotal case reports linking NSAID's and necrotizing fasciitis. Plausible biological mechanisms exist to explain how these drugs might predispose to serious infection and how they may mask signs and symptoms, therefore delaying diagnosis. In this series, less than half the patients were taking NSAID'S Diabetes and other co-morbidities were frequently found. The role of NSAIDS remains unclear.