Local variations in the epidemiology, microbiology, and outcome of necrotizing soft-tissue infections: a multicenter study

Am J Surg. 2011 Aug;202(2):139-45. doi: 10.1016/j.amjsurg.2010.07.041. Epub 2011 May 4.


Background: Necrotizing soft-tissue infections (NSTIs) are rare and highly lethal.

Methods: A retrospective chart review of patients with NSTIs treated at 6 academic hospitals in Texas between January 1, 2004 and December 31, 2007. Patient demographics, presentation, microbiology, treatment, and outcome were recorded. Analysis of variance, chi-square test, and logistic regression analysis were performed.

Results: Mortality rates varied between hospitals from 9% to 25% (n = 296). There was significant interhospital variation in patient characteristics, microbiology, and etiology of NSTIs. Despite hospital differences in treatment, primarily in critical care interventions, patient age and severity of disease (reflected by shock requiring vasopressors and renal failure postoperatively) were the main predictors of mortality.

Conclusions: Significant center differences occur in patient populations, etiology, and microbiology of NSTIs, even within a concentrated region. Management should be based on these characteristics given that adjunctive treatments are unproven and variations in outcome are likely because of patient disease at presentation.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Analysis of Variance
  • Chi-Square Distribution
  • Critical Care
  • Fasciitis, Necrotizing / epidemiology
  • Fasciitis, Necrotizing / microbiology
  • Female
  • Hospital Mortality
  • Hospitals, University / statistics & numerical data*
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Medical Records
  • Methicillin-Resistant Staphylococcus aureus* / isolation & purification
  • Middle Aged
  • Necrosis
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Soft Tissue Infections / epidemiology*
  • Soft Tissue Infections / microbiology*
  • Soft Tissue Infections / mortality
  • Soft Tissue Infections / pathology
  • Soft Tissue Infections / therapy
  • Texas / epidemiology
  • Treatment Outcome