Necrotizing Fasciitis in Patients With Spinal Cord Injury An Analysis of 25 Patients

Study Design. Retrospective chart review. Objective. The aim of this study was to analyze the correlation between necrotizing fasciitis (NF) and pressure ulcers, as well as the mortality, and complication rate, in patients with spinal cord injury (SCI). Summary of Background Data. Pressure ulcers represent a challenging problem, especially in immobilized patients. Necrotizing soft tissue infections arising from decubitus ulcers in patients with SCIs have been reported. Methods. Twenty-five SCI patients with NF treated between April 2000 and December 2009 were included in the study. All patients were analyzed in regard to the number of surgical debridements, length of hospital stay, and laboratory, microbiological, and histological assessments. Information about age, sex, preexisting conditions, anatomical localization, and etiology of the NF were acquired from the patients' medical records. Results. There were 19 paraplegic and 6 tetraplegic patients with a median age of 47 years. In 18 cases, NF developed in the setting of pressure sores. Grade 4 pressure sores were identified in 15 cases and grade 3 pressure sores in 3 cases. The incidence of developing NF is significantly higher in patients with fourth-grade pressure sores than in those with a lower-grade lesion (odds ratio = 2.91; 95% confidence interval, 1.29 6.56). The mean laboratory risk indicator for NF score was 6.6 upon admission. The most common bacteria were streptococci. During the hospital stay, six patients developed sepsis and two died because of septic multiorgan failure. Conclusion. Patients with grade 3 and 4 pressure sores had a significantly increased risk of developing NF. The current investigators recommend that close clinical and laboratory monitoring of all patients with grade 3 or 4 pressure sores is appropriate so that any early clinical signs of NF can be recognized and evaluated for early and aggressive treatment.