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Necrotizing Fasciitis in Patients with Spinal Cord Injury: An Analysis of 25 Patients.
MedLine Citation:
PMID:  21325991     Owner:  NLM     Status:  Publisher    
Study Design: Retrospective chart reviewObjective: The aim of this study was to analyze the correlation between necrotizing fasciitis and pressure ulcers, as well as the mortality and complication rate, in patients with spinal cord injury (SCI).Summary of Background Data: Pressure ulcers represent a challenging problem, especially in immobilized patients. Necrotizing soft tissue infections arising from decubitus ulcers in patients with SCIs have been reported.Methods: Twenty-five SCI patients with necrotizing fasciitis (NF) treated between April 2000 and December 2009 were included in the study. All patients were analyzed in regard to the number of surgical debridements, length of hospital stay and laboratory, microbiological and histological assessments. Information about age, sex, pre-existing conditions, anatomical localization and etiology of the necrotizing fasciitis were acquired from the patients´ medical records.Results: There were 19 paraplegic and six tetraplegic patients with a median age of 47 years. In 18 cases, necrotizing fasciitis developed in the setting of pressure sores. Grade four pressure sores were identified in 15 cases and grade three pressure sores in 3 cases. The incidence of developing NF is significantly higher in patients with fourth grade pressure sores compared to those with a lower grade lesion (odds ratio = 2.91; 95% confidence interval 1.29 - 6.56). The mean laboratory risk indicator for necrotizing fasciitis (LRINEC) score was 6.6 upon admission. The most common bacteria were streptococci. During the hospital stay, six patients developed sepsis and two died due to septic multi-organ failure.Conclusions: Patients with grade three and four pressure sores had a significantly increased risk of developing necrotizing fasciitis. The current investigators recommend close clinical and laboratory monitoring of all patients with grade 3 or 4 pressure sores is appropriate so that any early clinical signs of NF can be recognized and evaluated for early and aggressive treatment.
Mustafa Citak; Manuel Backhaus; Daniel J Tilkorn; Renate Meindl; Gert Muhr; Tobias Fehmer
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-15
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1 Department of Surgery, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany 2 Department of Spinal Cord Injury, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany 3 Department of Plastic Surgery, Burn Center, Hand Center, Sarcoma Reference Center, BG-University-Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
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