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.

中文翻译：

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使用和不使用高压氧治疗的坏死性筋膜炎和 Fournier 坏疽的结果：10 年的回顾性分析

坏死性软组织感染 (NSTI) 需要立即彻底清创、广谱抗生素和重症监护。高压氧治疗 (HBOT) 可以辅助进行，但仍然缺乏明确的证据证明其益处。我们进行了一项回顾性单中心研究，包括 192 名坏死性筋膜炎或 Fournier 坏疽患者，以评估住院死亡率和结果，取决于患者、疾病和治疗特征，有或没有 HBOT。住院死亡率为27.6%。根据多变量分析，与死亡率增加相关的因素是较高的年龄、多发性或问题定位的影响（优势比 (OR) = 2.88，P = 0.003），尽管有临床指征但不适合 HBOT（OR = 8.59，P = 0.005），病原体在血培养中（OR = 3.36，P = 0.002），并发症（OR = 10.35，P < 0.001）和脓毒症/器官功能障碍（OR = 19.58，P < 0.001）。与更好的生存率相关的因素包括真空辅助伤口闭合（OR = 0.17，P < 0.001）、大量清创（OR = 0.83，P < 0.001）和网状移植物闭合缺损（OR = 0.06，P < 0.001）或皮瓣（OR = 0.09，P = 0.024）。当参与者被分为不需要 HBOT（n = 98）、接受 HBOT 治疗（n = 83）和由于禁忌症而不适合 HBOT（n = 11）的亚组时，前两组的生存率相似（75.5% vs. 73.5%）和相似的结果，尽管 HBOT 患者遭受更严重的 NSTI，反映为更频繁的多发定位（P < 0.001）、入院时脓毒症（P < 0.001）和重症监护治疗（P < 0.001），更多的清创（P < 0.001）和更多的抗生素（P = 0.001）。在不适合 HBOT 的亚组中，生存率明显更差（36.4%，P = 0.022）。这些结果表明 HBOT 对治疗重症患者的 NSTI 有益。