986. Characteristics and Short-Term Outcomes of Necrotizing Fasciitis
Session: Poster Abstract Session: Clinical Studies of Bacterial Infection
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Necrotizing fasciitis is a rare, rapidly progressive, and potentially fatal infection.  We used public hospital discharge databases to determine current characteristics and outcomes of necrotizing fasciitis in the United States. 

Methods: Hospital discharge data was obtained from state agencies for California, New Hampshire, New Jersey, New York, Vermont and West Virginia for years ranging from 1995 to 2007.  Admissions which included the ICD-9 CM code 728.86 (necrotizing fasciitis) were included in the analysis.  Data documentation, ICD-9 CM diagnosis and procedure codes were used to quantify demographics, comorbidities, and outcomes including death, amputation, discharge status, length of stay, and total hospital charges.  

Results: 21,297 out of 82,501,059 screened included a diagnosis of necrotizing fasciitis (0.026%).   Common comorbitities included diabetes in 38.5%, hypertension in 34.5%, peripheral vascular disease in 14%, and drug or alcohol use in 17.8%.  The proportion of patients with diabetes varied by race and ranged from 58.9% in Native Americans to 9.5% in Asians. Over 75% of patients underwent some type of surgical procedure during their hospitalization.  In-hospital mortality decreased from 29% in 1995 to 13.8 % in 2007.  Mortality and likelihood of amputation increased significantly with age.  Female gender was associated with an increased rate of mortality (OR 1.29, p < 0.0001) and decreased rate of amputation (OR 0.6, p < 0.0001).  When corrected for age and gender, patients with Medicaid, private insurance, worker’s compensation, and the uninsured had higher mortality compared to Medicare (p<0.0001, p =0.03, p < 0.001, p < 0.0001, respectively).  There were no significant age-adjusted differences between races in mortality, but African American and Hispanic patients were more likely to undergo amputation.  HIV infection was the strongest predictor of mortality when corrected for age and gender (OR 2.11, p < 0.0001), while peripheral vascular disease was the strongest predictor of amputation (OR 11.90, p < 0.0001).

Conclusion:  Increasing age, female gender, HIV, and payor status were associated with higher mortality rates.  Necrotizing fasciitis remains an important cause of morbidity and mortality in the United States.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Rachel Simmons, MD, Massachusetts General Hospital, Boston, MA and David Kao, MD, Univeristy of Colorado Denver, Aurora , CO

Disclosures:

R. Simmons, None

D. Kao, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.