Outcome of necrotizing fasciitis and Fournier's gangrene with and without hyperbaric oxygen therapy

• Verfasst von: Mladenov, Assen [VerfasserIn]
• Verfasst von: Diehl, Katharina [VerfasserIn]
• Verfasst von: Müller, Oliver [VerfasserIn]
• Verfasst von: Heymann, Christian von [VerfasserIn]
• Verfasst von: Kopp, Susanne [VerfasserIn]
• Verfasst von: Ludwig-Peitsch, Wiebke [VerfasserIn]
• Titel: Outcome of necrotizing fasciitis and Fournier's gangrene with and without hyperbaric oxygen therapy
• Titelzusatz: a retrospective analysis over 10 years
• Verf.angabe: Assen Mladenov, Katharina Diehl, Oliver Müller, Christian von Heymann, Susanne Kopp and Wiebke K. Peitsch
• E-Jahr: 2022
• Jahr: 05 August 2022
• Umfang: 16 S.
• Fussnoten: Gesehen am 30.10.2023
• Titel Quelle: Enthalten in: World journal of emergency surgery
• Ort Quelle: London : BioMed Central, 2006
• Jahr Quelle: 2022
• Band/Heft Quelle: 17(2022), Artikel-ID 43, Seite 1-16
• ISSN Quelle: 1749-7922
• DOI: doi:10.1186/s13017-022-00448-6
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1868773507

Abstract

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.