Conclusion

Despite the progress made in therapy, the prognosis for soft-tissue anaerobic infections remains poor. Global mortality varies between 20 and 50 % in the various series and depends on initial location (Table 2.2.4-6).

Table 2.2.4-6. Mortality of anaerobic soft tissue infections depending on location (from our

own series of 30 cases)5.

. Neck only

12.5 %

. Limb only

18

%

. Perineum

32

%

. Abdomen

45

%

. Neck & Mediastinum

50

%

. Abdomen & Thorax

68

%

When infection affects only one limb, mortality is around 5 to 10% for necrotizing fasciitis and a little higher for myonecrosis: 10 to 20 %. Once it affects the abdomen & thorax it can reach 60% for necrotizing fasciitis. Sadly, survival is sometimes secured at the cost of extensive mutilation. Here HBO seems particularly effective in reducing functional sequelae related to loss of tissue or extremities.

Beyond the initial location, a number of factors exacerbate these infections: older patients; poor general health (e.g., alcoholism, diabetes, neoplasia); coagulation disorders (i.e., decreased prothrombin time, thrombocytopenia); hypothermia; jaundice; kidney failure; acute respiratory failure; shock; altered cconsciousness; and lastly late referral - perhaps the most obviously important factor85.

Given the therapeutic and anti-infective strategies available over the past ten years and in active use today, results are still not universally satisfactory. Further progress will depend on physicians carefully considering the following: (1) aggressive prophylaxis against and (2) immediate intensive treatment upon discovery of anaerobic infections98.

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