[Necrotizing infections of the soft tissues].

OBJECT

In necrotizing soft tissue infections (NSTI) may be implicated skin, subcutaneous tissue, fascia and skeletal muscle, and include different clinical entities associated with high morbidity and mortality rates. Diagnosis must be early and its initial management must be common.

METHODS

A retrospective study of 24 patients diagnosed of NSTI is made. Associated factors with the development of these infections, and its treatment are analysed. It is effectuated an statistical analysis of mortality and related factors.

RESULTS

Five cases were Necrotizing Cellulitis, fourteen Necrotizing Fasciitis, three Myonecrosis, one gangrenous pyoderma and one case was a disseminated gluteus abscess. Surgical treatment was resection and debridament--in every case reaching to healthy tissue. Broad-spectrum antibiotics were always associated to surgery. E. coli and Bacteroides have been the most frequent microorganism isolated. 23 patients were operated once at least; 66 surgical interventions were made (mean: 2.86; range: 1-7). Overall mortality of this series was 29%.

CONCLUSIONS

Early and aggressive treatment are the corner stone in the management of these patients. With such therapeutic premise, in our series we had a mortality of 29%. Factors associated with a worse outcome have been advanced age, the presence of an underlying disease in the moment of developing the infection and high levels of urea at admittance.