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 p =0.003, ventilator requirement >24h, 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.