Necrotizing Fasciitis Research Articles

Necrotising Fasciitis following Intramuscular Injection in a Nigerian Neonate: A case report

Necrotizing fasciitis (NF) is a rare but severe, life-threatening bacterial infection of the fascia, with secondary necrosis of the subcutaneous tissues. Necrotizing fasciitis is caused by an infection of the skin, subcutaneous tissue, and fascia by one or more bacterial organisms, resulting in the death of these tissues. NF is rare in neonates, but it has been reported following omphalitis, balanitis, mastitis, and postoperative complications. The mortality in neonates with necrotizing fasciitis has been reported to be as high as fifty per cent. We report a case of NF in a term male neonate with an intramuscular injection at the left shoulder at birth under suspected septic conditions. The wound swab yielded Escherichia coli and Pseudomonas species, while the blood culture yielded Staphylococcus aureus and Pseudomonas species. The infant received antibiotics, and the wound was debrided. He was discharged after sixteen days of hospitalization. This case is reported to highlight the possible role of injections under septic conditions as a risk for necrotizing fasciitis in the newborn. Health workers are encouraged to ensure aseptic skin preparation before injections.

Impact of Comorbidities on the Cause of Death by Necrotizing Soft Tissue Infections

Background: The aim of this study was to identify the cause of death in patients with necrotizing soft tissue infections (NSTIs) stratified by patient's pre-existing comorbidities (American Society of Anesthesiologists [ASA] classification 3/4 vs. ASA 1/2). Differences in clinical presentation, mortality rate, and factors associated with mortality between those two comorbidity groups were investigated. Patients and Methods: A retrospective multicenter study of patients with NSTIs between 2010 and 2020 was conducted. The primary outcome was the cause of death within the first 30 days. Furthermore, factors associated with mortality were identified. All analysis were stratified by severity of comorbidities (ASA 1/2 or ASA 3/4). Results: Of the 187 patients, 39 patients (21%) died within 30 days. American Society of Anesthesiologists 1/2 patients (overall mortality rate, 11%) died more often as direct result of the infection compared with ASA 3/4 patients (overall mortality rate, 33%) (ASA 1/2 group: 92% vs. ASA 3/4 group: 48%; p = 0.013). American Society of Anesthesiologists 3/4 patients died more often due to withdrawal of life-sustaining therapies based on assumed poor outcome after severe critical illness (ASA 1/2 group: 52% vs. ASA 3/4 group: 8%; p = 0.013). Conclusions: Mortality rates of patients with NSTIs varied from 11% in previously healthy patients to 33% in patients with multiple or severe comorbidities. The predominant cause of mortality was overwhelming infection and associated sepsis in healthy patients whereas in patients with multiple or severe pre-existing medical disease, death most often occurred after treatment limitations based on patient's wishes and prognosis.

Classification Model for Diabetic Foot, Necrotizing Fasciitis, and Osteomyelitis.

Simple SummaryNecrotizing fasciitis (NF) and osteomyelitis (OM) are severe complications in patients with diabetic foot ulcers (DFUs). Although NF and OM often cause results including limb amputation and death, definite diagnoses of these are challenging. To aid the prompt and proper diagnosis of NF and OM in patients with DFU, we developed and evaluated a novel prediction model based on machine learning technology. In summary, our prediction model appropriately discriminated the NF and OM from diabetic foot. Moreover, this prediction model has advantages in that it is based on the demographic data and routine laboratory results, which requires no additional examinations which are complicated or expensive.Diabetic foot ulcers (DFUs) and their life-threatening complications, such as necrotizing fasciitis (NF) and osteomyelitis (OM), increase the healthcare cost, morbidity and mortality in patients with diabetes mellitus. While the early recognition of these complications could improve the clinical outcome of diabetic patients, it is not straightforward to achieve in the usual clinical settings. In this study, we proposed a classification model for diabetic foot, NF and OM. To select features for the classification model, multidisciplinary teams were organized and data were collected based on a literature search and automatic platform. A dataset of 1581 patients (728 diabetic foot, 76 NF, and 777 OM) was divided into training and validation datasets at a ratio of 7:3 to be analyzed. The final prediction models based on training dataset exhibited areas under the receiver operating curve (AUC) of the 0.80 and 0.73 for NF model and OM model, respectively, in validation sets. In conclusion, our classification models for NF and OM showed remarkable discriminatory power and easy applicability in patients with DFU.

The application of negative pressure wound therapy in orthopedics: current concepts

We conducted a literature review to better understand the correct application and indications of negative pressure wound therapy (NPWT) in orthopedics and traumatology. A literature search was conducted on PubMed and all articles in English, Spanish, and Italian were included. Relevant articles, references, data, and relevant findings were identified, reviewed, extracted, and accepted by consensus of at least 66% of the researchers. Relevant articles were discussed by the research group. NPWT has several beneficial effects on the wound that contribute to the maintenance of a favorable biochemical and cellular environment, to the formation of granulation tissue and to faster healing. NWPT can be useful in the treatment of septic wounds after initial debridement surgery and removal of the septic foci, and in necrotizing fasciitis in the presence of gas gangrene, venous or pressure ulcers. NPWT can also be used “for prophylactic purposes” (incisional NPWT) in patients with risk factors for skin dehiscence and with a high risk of wound drainage in the post-operative period and after prosthetic surgery or internal fixation to protect the surgical scar. However, the available evidence is mostly unclear. The appropriate use of NPWT seems to reduce the number of dressing changes in complex wounds, reduce hospitalization times, and offer greater comfort to the patient; when applied on surgical incisions, it may reduce the risk of delayed healing and the risk of infections.

Ecthyma gangrenosum as a presenting feature of X-linked agammaglobulinemia: A case study.

A previously healthy 5-year-old boy presented with symptoms of fever, vomiting, and diarrhea for three days. He had extensive erythematous skin lesions mainly over his bilateral lower limbs. His parents were nonconsanguineous, and his two younger sisters were healthy. On arrival, he was in septic shock, thus requiring multiple fluid boluses, triple inotropes, and ventilation. The skin lesions started as macules that enlarged into papules and vesicles. Over the next 24 h, they rapidly evolved into multiple hemorrhagic bullae (Fig. 1A), which ruptured to form a gangrenous ulcer with gray-black eschar surrounded by an erythematous halo (Fig. 1B).

What are the Alternatives to the LRINEC Score in Identifying Necrotizing Soft Tissue Infections in the Emergency Department?

Background: The emergency department (ED) is an dynamically high-risk setting. Our aim is to determine the blood parameters associated with necrotizing soft tissue infections (NSTI) to strengthen the LRINEC score. 
 Materials and methods: We analyzed 109 patients who were diagnosed with necrotizing soft tissue infection in the Urology, Dermatology, Plastic surgery and General Surgery clinics of Atatürk University between 2013 and 2016. In the same period, we matched 624 patients diagnosed with cellulitis as a control group. 
 Results: Of four defined clinic's records to Atatürk University Hospital in 2013 to 2016, 109 matched and 624 matched control records were abstracted. Diagnoses associated with the NSTIs were: gangrene (n=47), gas gangrene (n=7), Fournier's gangrene (n=44) and necrotizing fasciitis (n=11). In patients with Necrotizing Soft Tissue Infection, BUN (p=0,00), K (0,011), Neutrofil (p=0,013), Lenfosit (p=0,003), Htc (p=0,00), RDW (p=0,002), Plt (p=0,042), AST (p=0,00), ALT (p=0,00) and INR (p=0,003) values were found to be statistically significant in making the diagnosis. 
 Conclusion: BUN, K, Neutrofil, Lenfosit, Htc, RDW, Plt, AST, ALT and INR values measured from blood tests of patients diagnosed with NSTI can be used in distinctive diagnosis of Soft Tissue Infection (STI). Increased awareness of these values may improve Emergency Department (ED) decision making and prevent miss diagnose.

Retrospective case series: Necrotising fasciitis in 23 dogs.

Necrotising fasciitis (NF) is a rare, rapidly progressive subcutaneous bacterial infection. Few studies have characterised NF in dogs. To retrospectively describe clinical and laboratory findings, with treatments and outcomes, in dogs with NF. Twenty-three client-owned dogs treated at a veterinary teaching hospital between 1998 and 2021. Medical records and laboratory data from 23 dogs diagnosed with NF were reviewed. Male dogs were significantly over-represented (p= 0.003). The most common presenting complaint was sudden lameness. Infection occurred in one or two limbs in 19 of 23 dogs, with right hindlimbs most often affected (13 of 23). Pitting oedema was evident in 14 of 23 dogs. Antibiotic and nonsteroidal anti-inflammatory drugs were administered before presentation in nine and 13 of 23 dogs, respectively. Common clinicopathological abnormalities included hypoalbuminemia, hyponatremia, elevated liver enzymes, elevated creatine kinase, increased bands and lymphopenia. Streptococcus canis was isolated from 18 of 23 dogs. Histopathological features included acute necrosis and severe neutrophilic inflammation. Fifteen dogs were euthanised or died, while surgical intervention led to survival in eight of 23 dogs. Dogs presenting for acute swelling of a limb with oedema should have the diagnosis of NF considered and early surgical intervention might increase survival.

Risk Factors and Predictors of Outcome for Necrotising Fasciitis

Abstract Background:Necrotising fasciitis(NF) is one of the most fulminant infection of skin and soft tissue. It is a fatal rapidly progressing disease causing Multi organ Dysfunction syndrome (MODS), septic shock & death if not identified early & treated accordingly. The aim is to study risk factors associated with NF and predictors of outcome. Settings & design: Prospective observational study in a single tertiary care center. Materials and Methods:Prospective analysis of patients with NF from March 2018 – August 2019 was done. The known risk factors were studied. Results: A Total 120 patients were reviewed. Out of which 81 (67.5%) were males and 39 (32.5%) were females. The mortality rate in our study was 14.16%. It was significantly high in patients with CRF (p 0.045), HIV (p <0.001), Diabetes with other risk factors (p 0.003),BSA > 10% (p <0.01), Type 3 culture (0.027),LRINEC score >6 (p 0.015). Conclusion:NF in patients with known risk factors progresses rapidly, so aggressive treatment should be given at the earliest. Early identification & prompt intervention is the key for better survival outcome in NF.

Understanding the Prodromal Period of Necrotizing Soft Tissue Infections of the Genitalia (Fournier's Gangrene) and the Incidence, Duration, and Risk Factors Associated With Potential Missed Opportunities for an Earlier Diagnosis: A Population-based Longitudinal Study.

The purpose of this paper was to investigate patterns of health care utilization leading up to diagnosis of necrotizing soft tissue infections of the genitalia and to identify risk factors associated with potential diagnostic delay. IBM MarketScan Research Databases (2001-2020) were used to identify index cases of necrotizing soft tissue infections of the genitalia. We identified health care visits for symptomatically similar diagnoses (eg, penile swelling, cellulitis) that occurred prior to necrotizing soft tissue infections of the genitalia diagnosis. A change-point analysis identified the window before diagnosis where diagnostic opportunities first appeared. A simulation model estimated the likelihood symptomatically similar diagnosis visits represented a missed opportunity for earlier diagnosis. Patient and provider characteristics were evaluated for their associations with delay. We identified 8,098 patients with necrotizing soft tissue infections of the genitalia, in which 4,032 (50%) had a symptomatically similar diagnosis visit in the 21-day diagnostic window, most commonly for "non-infectious urologic abnormalities" (eg, genital swelling; 64%): 46% received antibiotics; 16% saw a urologist. Models estimated that 5,096 of the symptomatically similar diagnosis visits (63%) represented diagnostic delay (mean duration 6.2 days; mean missed opportunities 1.8). Risk factors for delay included urinary tract infection history (OR 2.1) and morbid obesity (OR 1.6). Visits to more than 1 health care provider/location in a 24-hour period significantly decreased delay risk. Nearly 50% of insured patients who undergo debridement for, or die from, necrotizing soft tissue infections of the genitalia will present to a medical provider with a symptomatically similar diagnosis suggestive of early disease development. Many of these visits likely represent diagnostic delay. Efforts to minimize logistic and cognitive biases in this rare condition may lead to improved outcomes if they lead to earlier interventions.

Surgical Management of Necrotizing Fasciitis of the Head and Neck.

The purpose of this study was to highlight risk factors and surgeries for necrotizing fasciitis (NF) of the head and neck in the literature. NF is rare but can rapidly progress. A literature search was done using PubMed and SCOPUS. Articles that discussed NF of the head and neck and a specific surgical technique were included. A bivariate Pearson correlation was conducted using an α level of 0.05. The study included 31 articles encompassing 77 patients who presented with head and neck NF. Diabetes mellitus (23.4%) was the most common comorbidity observed. Surgical techniques, such as debridement (96.10%) and incision/exploration (97.40%), were common. Immediate surgical intervention should be performed when treating patients presenting with NF of the head and neck.

A Case Report of Rapidly Necrotizing Fasciitis Post-Falling Down Treated Reconstructively

Necrotizing fasciitis (NF) is a necrotizing soft tissue infection that can result in fast tissue loss, necrosis, and potentially fatal acute sepsis. Diabetes, cancer, alcohol abuse, and chronic liver and renal disease are all risk factors for NF. In this case report, a 19-year-old man with a negative past medical and surgical history was diagnosed with aggressive rapidly progressive necrotizing fasciitis of the left lower extremity after a recent history of falling down from a skateboard. A successful treatment with long-term debridement surgeries followed by reconstructive surgery with skin grafting was made. Although the severity of this condition, the patient was able to resume a normal range of motion of the concerned extremity. NF has been described in the literature, but early diagnosis, which is crucial for successful management, rests a challenge.

Lower Extremity Necrotizing Fasciitis Managed With Negative Pressure Wound Therapy (NPWT) and Split-Thickness Skin Graft: A Case Report

Introduction: Necrotizing fasciitis (NF) is an infection of the soft tissues (skin, subcutaneous tissue and fascia) that implies a rapidly and progressive evolution. In general, the treatment consists of stabilizing the patient, as well as the use of antibiotics that cover the most common agents, however, in most cases this is not useful without definitive management that consists of cleaning and surgical debridement. In addition to surgical lavage, adjunctive measures are often used in the treatment of complex wounds, such as vacuum-assisted closure (VAC) systems, also known as microdeformation wound therapy (MDWT) or negative pressure wound therapy (NPWT). Objective: The objective is to present a successful case in the treatment of necrotizing fasciitis by negative pressure therapy with subsequent placement of grafts.

Sarcopenia Is Associated With Increased Mortality in Patients With Necrotizing Soft Tissue Infections.

Necrotizing soft tissue infections (NSTIs) are surgical emergencies associated with high morbidity and mortality. Identifying risk factors for poor outcome is a critical part of preoperative decision-making and counseling. Sarcopenia, the loss of lean muscle mass, has been associated with an increased risk of mortality and can be measured using cross-sectional imaging. Our aim was to determine the impact of sarcopenia on mortality in patients with NSTI. We hypothesized that sarcopenia would be associated with an increased risk of mortality in patients with NSTI. This is a retrospective cohort study of NSTI patients admitted from 1995 to 2015 to two academic institutions. Operative and pathology reports were reviewed to confirm the diagnosis in all cases. Average bilateral psoas muscle cross-sectional area at L4, normalized for height (Total Psoas Index [TPI]), was calculated using computed tomography (CT). Sarcopenia was defined as TPI in the lowest sex-specific quartile. Primary outcome was in-hospital mortality. Multivariate logistic regression was performed to assess the association between sarcopenia and in-hospital mortality. There were 115 patients with preoperative imaging, 61% male and a median age of 57y interquartile range (IQR 46.6-67.0). Overall in-hospital mortality was 12.1%. There was no significant difference in sex, body mass index (BMI), comorbidities and American Society of Anesthesiologists classification (Table1). After multivariate analysis, sarcopenia was independently associated with increased in-hospital mortality (Odds ratio, 3.5; 95% Confidence Interval [CI], 1.05-11.8). Sarcopenia is associated with increased risk of in-hospital mortality in patients with NSTIs. Sarcopenia identifies patients with higher likelihood of poor outcomes, which can possibly help surgeons in counseling their patients and families.

Regional Variations in Microbiology and Outcomes of Necrotizing Soft Tissue Infections: A Systematic Review and Meta-Analysis

Background: Frequency, microbiology, and outcomes of necrotizing soft tissue infections (NSTIs) could vary across the United States because of differences in locoregional and environmental factors. We synthesized the literature from across the regions of the United States on NSTIs in a systematic review/meta-analysis. Methods: PubMed, ProQuest, Scopus, and Web of Science databases were systematically searched and screened. DerSimonian-Laird random-effects meta-analyses were performed using 'meta' package in R to determine pooled prevalences. Meta-regression analyses examined moderator effects of risk factors. Results: Twenty-seven studies (2,242 total patients) were included. Pooled prevalences of polymicrobial and monomicrobial infections were 52.2% and 39.9%, respectively. The prevalence of monomicrobial NSTIs increased over the last two decades (p = 0.018), whereas polymicrobial infections declined (p = 0.003). Meta-regression analysis showed that most polymicrobial NSTIs were Fournier gangrene (p < 0.001), whereas monomicrobial NSTIs mostly affected extremities (p < 0.001). Staphylococcus aureus was the most common organism isolated (predominantly in the South), followed by Bacteroides spp. (predominately in the East) and Streptococcus pyogenes. Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 11.9% of NSTIs, mainly in the South. The overall mortality rate was 17.8% and declined over last two decades (p < 0.001), with the lowest rate reported in the last decade at 13% without any regional differences. Conclusions: Advancement in the management of NSTIs may have contributed to the observed decline in NSTI-related mortality in the United States. However, the proportion of monomicrobial NSTIs seems to be increasing, possibly because of increased comorbidities affecting extremities. Causative organisms varied by region. Multi-center observational studies are warranted to confirm our observations.

Stromal vascular fraction-enriched fat grafting as treatment of adherent scars: study design of a non-randomized early phase trial

BackgroundIn the last decades, autologous fat grafting has been used to treat adherent dermal scars. The observed regenerative and scar-reducing properties have been mainly ascribed to the tissue-derived stromal vascular fraction (tSVF) in adipose tissue. Adipose tissue’s components augment local angiogenesis and mitosis in resident tissue cells. Moreover, it promotes collagen remodeling. We hypothesize that tSVF potentiates fat grafting-based treatment of adherent scars. Therefore, this study aims to investigate the effect of tSVF-enriched fat grafting on scar pliability over a 12-month period.Methods and designA clinical multicenter non-randomized early phase trial will be conducted in two dedicated Dutch Burn Centers (Red Cross Hospital, Beverwijk, and Martini Hospital, Groningen). After informed consent, 46 patients (≥18 years) with adherent scars caused by burns, necrotic fasciitis, or degloving injury who have an indication for fat grafting will receive a sub-cicatricic tSVF-enriched fat graft. The primary outcome is the change in scar pliability measured by the Cutometer between pre- and 12 months post-grafting. Secondary outcomes are scar pliability (after 3 months), scar erythema, and melanin measured by the DSM II Colormeter; scar quality assessed by the patient and observer scales of the Patient and Observer Scar Assessment Scale (POSAS) 2.0; and histological analysis of scar biopsies (voluntary) and tSVF quality and composition. This study has been approved by the Dutch Central Committee for Clinical Research (CCMO), NL72094.000.20.ConclusionThis study will test the clinical efficacy of tSVF-enriched fat grafting to treat dermal scars while the underlying working mechanism will be probed into too.Trial registrationDutch Trial Register NL 8461. Registered on 16 March 2020

Amazon and Brazilian Polyherbal Preparation for Treatment of Necrotizing Fasciitis

Necrotizing fasciitis (flesh-eating disease) is a rare but life-threatening condition. We report one case of severe necrotizing fasciitis affecting the leg at risk of being amputated due to infection, before and after treatment with medicinal plants which have empirical broad-spectrum antibiotic and anti-inflammatory properties. All the medical attempts with conventional antibiotics failed and we had to act rapidly in order to cure the infection and prevent the amputation. These results suggest that certain medicinal plants could represent a treatment option and that further studies are considered.

Necrotizing fasciitis in sub-Saharan Africa: A study of 224 cases

Background: The aim of this study was to describe the epidemiological, clinical aspects, and outcome of necrotizing fasciitis (NF) in sub-Saharan Africa. Patients and Method: We conducted a descriptive study in hospital dermatology departments in five sub-Saharan African countries over a two-year period (April 2017 to July 2019). Patients over fifteen years of age received for NF were included. Results: During the study period, 224 patients with NF were included. Their mean age was 51.9 ± 18.3 years and their sex ratio (M/F) was 1.3. NF was present in the lower limbs in 88.8% (n = 199) of the patients. The main local signs of NF were cutaneous necrosis (83.9%; n = 188) and spontaneous intense pain (75.9%; n = 170). NSAIDs (32.6%; n = 73), obesity (16.5%; n = 65), the use of decoctions/poultices (21.4%; n = 48), diabetes (16.5%; n = 37), nicotine addiction (11.6%; n = 26), alcoholism (8%; n = 18), voluntary cosmetic depigmentation (6.7%; n = 15), and HIV infection (3.8%; n = 8) were the main comorbidities. We recorded 14.7% (n = 33) of deaths. Conclusion: This study shows that NF of the lower extremities is the most often observed clinical form in sub-Saharan Africa. Some factors or comorbidities (diabetes, obesity, alcoholism, nicotine addiction) seem to be relatively frequent.

The LRINEC Score-An Indicator for the Course and Prognosis of Necrotizing Fasciitis?

Background: The Laboratory Risk Indicator for Necrotizing Fasciitis score (LRINEC) is a simple tool used to support early diagnosis of Necrotizing Fasciitis (NF). The aim of this study was to investigate whether the LRINEC is suitable as a progression and prognosis parameter in patients with NF. Methods: In this retrospective study, laboratory data of 70 patients with NF were analyzed. The LRINEC was calculated for every patient at the time of hospital admission and postoperatively after surgical interventions. Furthermore, the LRINEC was examined as a prognostic factor for survival. Results: The overall lethality of our series was 20 out of 70 (28.6%). A highly significant LRINEC decrease was found for serial debridements. The largest decrease was observed after the first debridement. There was a significant difference between the initial LRINEC of deceased and surviving patients. A cut off value of >6.5 (7 LRINEC points) resulted in an optimal constellation of sensitivity (70%) and specificity (60%) to predict lethality in patients with NF. Conclusions: The LRINEC significantly decreases after surgical debridement. An initial LRINEC equal or greater than seven is an independent prognostic marker for lethality and can help to identify high-risk patients.

Factors Affecting the Time to First Dose Antibiotic in Sepsis in Acute Emergency.

BackgroundThe Surviving Sepsis Campaign recommends the administration of antibiotics within 1 hour of triage time in sepsis patients. The purpose of this study was to determine the factors affecting the time to first dose antibiotics in sepsis patients presenting to the emergency department (ED).MethodsWe conducted a prospective observational study on factors affecting the time to first dose antibiotics in patients with sepsis presenting to the ED over a period of 7 months (July 2019 to January 2020). The purpose of this study was to determine the factors affecting the time to first dose antibiotics in sepsis patients.ResultsDuring the study period, a total of 410 patients with a mean age of 51.6 years were presented to the ED with sepsis. Majority was triaged to priority 1 (84.8%). The median door to antibiotic time was 50 minutes (IQR, 40–90). Two-thirds (68%) of the patients (279) received antibiotics within 60 minutes. The blood culture positivity rate was 22.9%, and the contamination rate was 6%. The most common factors for the delay were atypical presentation (36.6%) and unknown focus of infection (36.6%). Triage to non-acute areas of the ED (priority 2) was associated with delayed antibiotic administration [odds ratio (OR), 7.3; 95% confidence interval (CI), 4.03–13.36; p-value <0.001]. Patients presented with cellulitis and necrotizing soft tissue infection (NSTI) had received antibiotics within an hour compared to other diagnoses (18.3 vs 8.4%; OR, 2.4; 95% CI, 1.2–4.9; p = 0.009).ConclusionTwo-thirds of our patients received their first dose of antibiotics within an hour of presentation to the ED. Triage to lower priorities was an independent risk factor for delay in first-dose antibiotic administration, and patients presented with an obvious focus of infections like cellulitis and NSTI received their first dose of antibiotic much earlier when compared to other diagnoses.How to cite this articleJoseph JV, Madhiyazhagan M, Roshan R, Dhanapal SG, Arul S, Abhilash KPP. Factors Affecting the Time to First Dose Antibiotic in Sepsis in Acute Emergency. Indian J Crit Care Med 2021;25(10):1155–1160.

Necrotizing Fasciitis: Evaluation of 85 Cases and Usage of LRINEC Score.

The present study aims to define the characteristics of the necrotizing fasciitis (NF) cases followed at our hospital and to compare our results with the literature. In this study, NF cases followed and treated at our hospital from January 2005 to April 2019 were evaluated retrospectively. A total of 85 cases of NF were included in the study. Of the cases, 33 (39%) were female and the median age was 59.8±13.1 years (range: 26-92 years). Diabetes mellitus (DM) (56%) was the most prevalent comorbid condition. Extremities were the most frequently involved field found in 41 (48%) of the cases followed by Fournier's gangrene found in 34 (40%) of the cases. All of the cases had undergone surgical intervention (debridement and/or amputation) and received broad-spectrum antibiotic therapy. Laboratory risk indicator for necrotizing fasciitis (LRINEC) score was calculated for 60 cases, and it was 6 or higher in 78% of them. Nineteen (22%) of 85 cases had died. Necrotizing fasciitis affects generally older male patients with DM. In NF cases to avoid the higher risk of mortality, the removal of necrotic tissue via surgical procedure together with antimicrobial therapy is required urgently; therefore, it is very important to differentiate NF from soft tissue infections as soon as possible. As the LRINEC score predicted NF among nearly 80% of our patients, this score could be used as an early diagnostic tool of NF. Level IV, case series.