Necrotizing fasciitis and its association with Diabetes Mellitus

To analyze the different presentation, types of infection, predisposing factors (particularly diabetes mellitus) of necrotizing fasciitis; a rare potentially fatal rapidly progressing necrotizing infection of subcutaneous tissue and superficialfascia with secondary necrosis of overlying skin, the medical records were reviewed retrospectively of 94 patients (71 male; 23 female) admitted to the surgical intensive care unit of Hamad General Hospital, Qatar, between January 1995 and February 2005. Fifty-three patients (56.4%) were diabetic with a mean age of 55 years compared with 40.2 years in non-diabetic patients. Type 1 necrotizing fasciitis, especially of the perineal and genital regions, was more common in diabetic patients whereas type 2 necrotizing fasciitis, especially of torso and upper limbs, was more common in non-diabetic patients. Overall 63.4% of cases were type 2 necrotizing fasciitis. E.coli was the most common bacterium isolated from necrotic tissue of diabetic patients and streptococci were the most common cause of necrotizing fasciitis in non-diabetic patients. Fifteen (16%) patients died but there was no significant difference in mortality between the groups, eight (15.1%) diabetic, seven (17.1%) non-diabetic, although diabetic patients were significantly older.