Rieger Ulrich M, Gugger Christine Y, Farhadi Jian, Heider Ilonka, Andresen Reimer, Pierer Gerhard, Scheufler Oliver
Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basel, Switzerland.
Ann Plast Surg. 2007 May;58(5):523-30. doi: 10.1097/01.sap.0000244978.27053.08.
Necrotizing fasciitis and myositis are life-threatening infections involving the superficial fascia and musculature, respectively. Outcome depends on early diagnosis and aggressive treatment. Here, we aimed to determine prognostic factors for necrotizing soft tissue infections.The medical records of 16 consecutive patients diagnosed with necrotizing fasciitis (n = 13) and necrotizing myositis (n = 3) from 1999 to 2004 were retrospectively reviewed. Overall survival was 81.3% for necrotizing soft tissue infections, 84.6% for necrotizing fasciitis, and 66.7% for necrotizing myositis. Injection drug use was the most common cause of infection (31.3%). Frequent comorbidities were diabetes mellitus and hepatitis B and C (25.0%). As infectious agents, group A streptococci (GAS) were identified in 10 patients and multiple pathogens in 6 patients. Lethal outcome was always associated with GAS infection and streptococcal toxic shock syndrome (STSS). In our patients, myonecrosis, GAS infection, and STSS appeared to be negative prognostic factors for survival in necrotizing soft tissue infections.
坏死性筋膜炎和坏死性肌炎分别是累及浅筋膜和肌肉组织的危及生命的感染。预后取决于早期诊断和积极治疗。在此，我们旨在确定坏死性软组织感染的预后因素。回顾性分析了1999年至2004年连续诊断为坏死性筋膜炎（n = 13）和坏死性肌炎（n = 3）的16例患者的病历。坏死性软组织感染的总体生存率为81.3%，坏死性筋膜炎为84.6%，坏死性肌炎为66.7%。注射吸毒是最常见的感染原因（31.3%）。常见的合并症为糖尿病以及乙型和丙型肝炎（25.0%）。作为感染病原体，10例患者中鉴定出A组链球菌（GAS），6例患者中鉴定出多种病原体。致命结局总是与GAS感染和链球菌中毒性休克综合征（STSS）相关。在我们的患者中，肌坏死、GAS感染和STSS似乎是坏死性软组织感染生存的负面预后因素。
