7% and 73% (mean 32.2%)

[3]. Unfavorable prognostic factors include old age, peripheral vascular insufficiency, and diabetes (Table 3.). Patients with diabetes appear to be particularly at great risk, representing over 70% of cases in one large review [10]. Table 3 Risk factors for development of NSTI and the LRINEC scoring system for prediction of NSTI Risk factors   LRINEC scoring system     Variable Values Score Preexisting conditions C-reactive protein ≤150 mg/L 0 diabetes, immunosupression   > 150 mg/L 4 alcoholism, peripheral vascular disease, IV buy Tideglusib drug abuse, hypertension, corticosteroids, HIV, age < 50 years, GI malignance, malnutrition, major trauma, surgery, perforated viscera, chronic live disease, chronic renal insufficiency, obesity White blood cell

count < 15 per mm2 0     15-25 per mm2 1     > 25 per mm2 2   Hemoglobin ≤13,5 g/dL 0     11-13,5 g/dL 1     < 11 g/dL 2   Sodium ≥ 135 mmol/L 0     > 135 mmol/L 2 Existing illness and injuries Creatinine < 141 μmol/L 0 Varicella with bacterial superinfection, fractures, liposuction, seawater-seafood, Selleck BTK inhibitor surgery, spider bite and other bites, Cesarean section, burns   > 141 μmol/≤L 2   Glucose ≤10 mmol/L 0     > 10 mmol/L 1 NSTI-necrotizing soft tissue infection; GI-gastrointestinal; HIV-human immunodeficiency virus; LRINEC-Laboratory Risk Indicator for Necrotizing Fasciitis: A score of ≥ 6 is suspicious for NSTI, a score of ≥8 is highly predictive of NSTI The causes of NF on the CW are usually related to some form of trauma, tumor resection, irradiation or surgical procedure. The incidence of sternal wound infection with osteomyelitis after median sternotomy is 0.4% to 5.9%, and mortality is as high as 70% in infected 6-phosphogluconolactonase patients [11]. Tube thoracostomy for empyema is a particularly noteworthy cause where the mortality is about 89%, which is approximately

twice as high t as that reported for other anatomic sites [4, 12]. Delay or inadequate surgical debridement and severity of the underlying thoracic condition, are responsible for the high mortality rates. The importance of early, aggressive and often serial surgical debridements with removal of one or more ribs cannot be overemphasized [11]. Fournier’s gangrene in elderly patients and diabetics is usually described as a fulminating infection of the inguinal region and the lower AW and the perineum along with the scrotum and penis in men, and the vulva in women. Fournier originally reported a disease that was idiopathic in nature, but many recent studies suggest a polymicrobial etiology of this disease. The idiopathic causes are seen very often in younger populations [13]. The main sources of infection are elective skin operations, skin abscesses and pressure sores. The frequent colorectal disease includes anorectal infections, ischiorectal abcesses, colon perforations, and some elective anorectal diagnostic procedures e.g., rectal biopsy, anal dilatation, or hemorrhoidal banding.