Infectious Diseases Department, Middlemore Hospital, Auckland, New Zealand.
Intern Med J. 2011 Jul;41(7):543-8. doi: 10.1111/j.1445-5994.2009.02137.x. Epub 2009 Dec 4.
Early recognition of necrotizing fasciitis (NF) can be difficult, but is important as infections progress rapidly and have significant mortality. The aim of this study of patients with NF was to determine the clinical characteristics at presentation, causative pathogens and subsequent clinical outcome.
We retrospectively reviewed consecutive patients with NF presenting to Middlemore Hospital from January 2000 to June 2006.
Eighty-two patients were evaluated: 56% male, mean age 54.9 years (standard deviation 18.5), 40% Pacific Islanders. The site of infection was the lower limb in 46 (56%) patients, upper limb in 12 (15%) patients and perineum in 13 (16%) patients. Twenty-two (27%) patients were taking non-steroidal anti-inflammatory drugs, 29 (35%) had diabetes mellitus, 25 (30%) had gout and 17 (21%) had congestive heart failure. Forty-nine (60%) patients had a surgical procedure within 24 h of admission. Streptococcus pyogenes was isolated from tissue or blood cultures in 33 (40%) patients and 26 (32%) patients had polymicrobial infection. Twenty-five (30%) patients died, 17 (68%) within 72 h of admission. Independent predictors of mortality include congestive heart failure (P = 0.033) and a history of gout (P = 0.037).
NF remains an important disease in our community with significant morbidity and mortality. Pacific Islanders were disproportionately represented. Early diagnosis of NF can be difficult and requires a high index of suspicion in all patients presenting with cellulitis or unexplained sepsis. Congestive heart failure and gout are independent predictors of mortality and patients with these conditions and sepsis need early assessment with more aggressive hospital triaging.
坏死性筋膜炎（NF）的早期识别可能较为困难，但十分重要，因为感染迅速进展，且死亡率较高。本研究旨在分析 NF 患者的临床表现、致病病原体及后续临床结局。
我们对 2000 年 1 月至 2006 年 6 月期间在米德尔莫尔医院就诊的连续 NF 患者进行了回顾性分析。
共 82 例患者入组：男性占 56%，平均年龄 54.9 岁（标准差 18.5），40%为太平洋岛民。感染部位为下肢 46 例（56%）、上肢 12 例（15%）、会阴 13 例（16%）。22 例（27%）患者正在服用非甾体抗炎药，29 例（35%）患有糖尿病，25 例（30%）患有痛风，17 例（21%）患有充血性心力衰竭。49 例（60%）患者在入院 24 h 内接受了手术。33 例（40%）患者的组织或血液培养中分离出化脓性链球菌，26 例（32%）患者为混合感染。25 例（30%）患者死亡，17 例（68%）患者在入院后 72 h 内死亡。死亡的独立预测因素包括充血性心力衰竭（P=0.033）和痛风病史（P=0.037）。
NF 在我们的社区中仍然是一种重要疾病，具有较高的发病率和死亡率。太平洋岛民的发病率较高。NF 的早期诊断可能较为困难，所有出现蜂窝织炎或不明原因脓毒症的患者均需高度怀疑该病。充血性心力衰竭和痛风是死亡的独立预测因素，存在这些情况和脓毒症的患者需要早期评估，以便更积极地分诊住院。
