Necrotising soft tissue infections of the perineum and genitalia. Bacteriology, treatment and risk assessment.

Necrotising soft tissue infections of the perineum and genitalia are associated with a high rate of mortality and morbidity. We reviewed the records of 29 consecutive patients to investigate the possible correlation between clinical outcome and number of types of bacteria cultured, focus of infection, presence of diabetes, patient age, renal function and delay until presentation. The patients had an average of 3.9 bacterial organisms cultured intra-operatively (range 1-9). Patients with a rectal focus of infection had a greater number of bacteria and required longer hospitalisation and more operative procedures than patients with dermal or urethral foci. Those over the age of 60 had significantly longer hospital stays and higher mortality. Diabetes and impaired renal function did not increase mortality or morbidity. Suprapubic cystostomy was required in 24 patients (83%), diverting colostomy in 9 (31%) and orchiectomy in 3 (10%). Six patients (21%) died despite broad spectrum antibiotics and aggressive and frequent surgical debridement.