Trends in 393 necrotizing acute soft tissue infection patients 2000-2008

Objective: To determine the outcomes effect of changing trends in patients with necrotizing acute soft tissue infections (NASTI) 2000-2008. Methods: A single institution retrospective chart review of all patients treated for NASTI. Results: There were 393 patients with mean age 50 years, diabetes 53%, % body surface area excised 3.5. Wounds were located on: extremity 57%, perineum 40%, trunk 26%. Wound cultures %: polymicrobial = 62, Staphylococci = 48, Streptococci = 31. Patients developing complications %: Pulmonary = 23, renal insufficiency/failure = 27. During the study period, overall mortality rate remained unchanged: 30/393 = 7.6% (5.5% for patients first admitted by burn/trauma/acute care surgery vs. 29% for all other services, p = 0.003). Significant annual increases were found in number of patients, p = 0.03, male sex, p = 0.000, transfer from outside hospital, p < 0.001, BMI p = 0.003, ventilator requirement >24 h, p = 0.0005, APACHE II p = 0.002, and number of patients developing any complication, p = 0.04. Statistically significant decreases annually were found in: days of antibiotic use, p = 0.008, number of operations required for excision, p = 0.02, development of non-wound infections, p = 0.002, and length of stay in days (LOS), p = 0.03. Conclusions: This is the largest cohort of NASTI patients from a single institution to date, demonstrating significantly shorter LOS and decreased non-wound infection rates in the face of increasing BMI and APACHE II scores. The increasing number of patients and BMI suggests a causal relationship between NASTI and obesity. Initial care by surgeons experienced in caring for these patients provides mortality rates well below the national average. (C) 2011 Elsevier Ltd and ISBI. All rights reserved.