Necrotising fasciitis: an 8.5-year retrospective case review in a New Zealand intensive care unit.

BACKGROUND: Necrotising fasciitis is a rare, rapidly progressive soft tissue infection associated with extensive necrosis, profound shock and high morbidity and mortality. Incidence worldwide is thought to be increasing. OBJECTIVE: To investigate the demographics, comorbidities, microbiological features, resource use and outcome of patients with necrotising fasciitis. We aimed to identify factors associated with mortality. DESIGN, PARTICIPANTS AND SETTING: A retrospective case and chart review was performed in consecutive patients with necrotising fasciitis admitted to the intensive care unit of a tertiary hospital between January 2000 and June 2008. RESULTS: 58 patients with necrotising fasciitis were admitted during the study period. Pacific Islander and Maori peoples were overrepresented. Comorbidities were consistent with previous studies except for a high incidence of gout. Lower limb was the most frequent site of infection (53%). Swelling (83%) and severe pain (76%) were the most common presenting features. Type 2 infection (52%) was more common than type 1 (43%). Mortality was 29%. Recent non-steroidal antiinflammatory drug use was reported by 43% of patients but not associated with mortality. Logistic regression modelling identified Acute Physiology and Chronic Health Evaluation (APACHE) II score, pre-existing abnormal renal function and gout to be associated with mortality. CONCLUSIONS: There is an higher incidence of necrotising fasciitis at our hospital in South Auckland than reported elsewhere. Maori and Pacific Islander people are at increased risk. In our patient sample APACHE II score, preexisting abnormal renal function and gout were associated with mortality.

An analysis of vulvar necrotizing fasciitis in the unique and ethnically diverse Hawaiian population.

Vulvar necrotizing fasciitis is a surgical emergency with a high rate of morbidity and mortality. Our case series adds seven patients to the literature and presents the first group that is predominantly of Pacific-Islander origin. This study not only confirms traditional risk factors such as diabetes mellitus, obesity and hypertension but investigates ethnicity and socioeconomic status as risk factors. Also presented is a case of recurrent necrotizing fasciitis initially involving the vulva, then the back. In any patient for which there is suspicion of vulvar necrotizing fasciitis, surgical diagnosis remains the gold standard and facilitates rapid debridement of all necrotic tissues. Aggressive surgical debridement with broad spectrum antibiotic coverage is required to minimize mortality.