Outcome of necrotizing fasciitis and Fournier's gangrene with and without hyperbaric oxygen therapy: a retrospective analysis over 10 years
Necrotizing soft tissue infections (NSTI) require immediate radical debridement, broad-spectrum antibiotics and intensive care. Hyperbaric oxygen therapy (HBOT) may be performed adjunctively, but unequivocal evidence for its benefits is still lacking. We performed a retrospective single-center study...
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| Main Authors: | , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
05 August 2022
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| In: |
World journal of emergency surgery
Year: 2022, Volume: 17, Pages: 1-16 |
| ISSN: | 1749-7922 |
| DOI: | 10.1186/s13017-022-00448-6 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1186/s13017-022-00448-6 Verlag, kostenfrei, Volltext: http://wjes.biomedcentral.com/articles/10.1186/s13017-022-00448-6 
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| Author Notes: | Assen Mladenov, Katharina Diehl, Oliver Müller, Christian von Heymann, Susanne Kopp and Wiebke K. Peitsch |
MARC
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| 245 | 1 | 0 | |a Outcome of necrotizing fasciitis and Fournier's gangrene with and without hyperbaric oxygen therapy |b a retrospective analysis over 10 years |c Assen Mladenov, Katharina Diehl, Oliver Müller, Christian von Heymann, Susanne Kopp and Wiebke K. Peitsch |
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| 520 | |a Necrotizing soft tissue infections (NSTI) require immediate radical debridement, broad-spectrum antibiotics and intensive care. Hyperbaric oxygen therapy (HBOT) may be performed adjunctively, but unequivocal evidence for its benefits is still lacking. We performed a retrospective single-center study including 192 patients with necrotizing fasciitis or Fournier's gangrene to assess in-hospital mortality and outcome dependent on patient, disease and treatment characteristics with or without HBOT. The in-hospital mortality rate was 27.6%. Factors associated with increased mortality according to multivariate analysis were higher age, affection of multiple or problem localizations (odds ratio (OR) = 2.88, P = 0.003), ineligibility for HBOT despite clinical indication (OR = 8.59, P = 0.005), pathogens in blood cultures (OR = 3.36, P = 0.002), complications (OR = 10.35, P < 0.001) and sepsis/organ dysfunction (OR = 19.58, P < 0.001). Factors associated with better survival included vacuum-assisted wound closure (OR = 0.17, P < 0.001), larger number of debridements (OR = 0.83, P < 0.001) and defect closure with mesh graft (OR = 0.06, P < 0.001) or flap (OR = 0.09, P = 0.024). When participants were stratified into subgroups without requirement of HBOT (n = 98), treated with HBOT (n = 83) and ineligible for HBOT due to contraindications (n = 11), the first two groups had similar survival rates (75.5% vs. 73.5%) and comparable outcome, although patients with HBOT suffered from more severe NSTI, reflected by more frequent affection of multiple localizations (P < 0.001), sepsis at admission (P < 0.001) and intensive care treatment (P < 0.001), more debridements (P < 0.001) and a larger number of antibiotics (P = 0.001). In the subgroup ineligible for HBOT, survival was significantly worse (36.4%, P = 0.022). These results point to a benefit from HBOT for treatment of NSTI in critically ill patients. | ||
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