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Mark A. Malangoni, MD

Arch Surg. 2005;140:158.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The mortality of necrotizing soft tissue infections has declined to 20% or less. Surgeons have made important contributions to disease management by establishing the principles of early recognition, adequate resuscitation, initiation of broad-spectrum antibiotics, and prompt debridement. No doubt, advances in diagnostic testing (computed tomography and magnetic resonance imaging) and the use of repeated operative debridement for source control,¹ as advocated in this study, contribute to the improved results. The mortality of these infections also depends on the presence of comorbid diseases, bacterial virulence (particularly, Streptococcus pyogenes and clostridia), and the genetically programmed response to severe infection.

This large series of patients with necrotizing soft tissue infections identifies a white blood cell count higher than 30 000 x 10³/µL, serum creatinine level higher than 2 mg/dL (176.8 µmol/L), and heart disease as predictors of mortality. The first 2 parameters were strongly associated with clostridial infection, the . . . [Full Text of this Article]

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