Medline ® Abstract for Reference 40
of 'Necrotizing soft tissue infections'
Cervical necrotizing fasciitis: clinical manifestations and management.
Mathieu D, Neviere R, Teillon C, Chagnon JL, Lebleu N, Wattel F
Clin Infect Dis. 1995;21(1):51.
Forty-five cases of cervical necrotizing fasciitis are reported, and their clinical, bacteriologic, and therapeutic implications are considered. Fasciitis was of dental origin in 78% of cases, pharyngeal in 16%, and surgical or posttraumatic in 6%. The condition extended to the face in 22% of cases, to the lower part of the neck in 56%, and to the mediastinum in 40%. Soft-tissue cultures were positive in 78% of cases. Anaerobes were isolated along with aerobes in 49% of cases (mean, 2.2 isolates per patient) and in pure culture in 22%. Treatment included surgical debridement and drainage and the administration of antibiotics active against both anaerobic and gram-negative aerobic bacteria. Hyperbaric oxygen was used for adjunctive treatment. The bacteria involved did not affect clinical manifestations, extension, or mortality. The survival rate among our patients was 78%. Mortality was significantly higher among cases with mediastinal extension (44% vs. 7%; P<.01); thus the prompt recognition and drainage of sites of mediastinal extension are of critical importance. Other risk factors for death were an age of>70 years, underlying diabetes, the development of septic shock within 24 hours after admission, and prolonged prothrombin time.
Service d'Urgence Respiratoire, de Réanimation Médicale et de Médecine Hyperbare, Hôpital Albert Calmette, Lille, France.