To assess factors that might predict serious necrotizing soft tissue infections following illicit drug injection.Design: A retrospective review of a consecutive case series.Setting: An urban municipal hospital.Patients: Thirty patients presenting with cutaneous abscesses resulting from illicit drug injections during a 5-year period. All cases presented clinically with fluctuance, erythema, or induration but required extensive debridement at the time of incision and drainage.Interventions: Operative treatment employed wide incision, routine subfascial examination, and aggressive debridement. Clinical management included broadspectrum antibiotics, critical care support, and reconstructive procedures. Main Outcome Measures: Mortality, extent of debridement, preoperative vital signs and laboratory values, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, bacteriologic and pathologic test results.Results: Postoperatively, all patients were housed in the intensive care unit for 8.4 ± 14.5 days. Six patients died (20%). On arrival at the intensive care unit, systolic blood pressure was 80 mm Hg or less in 2 patients, 1 of whom died. White blood cell count on hospital admission was

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