Use cold steel on life-threatening pelvic infections. (Antibiotics are Adjunctive).

VAIL, COLO. -- Even the most potent broad-spectrum intravenous antibiotics are reduced to adjunctive therapy status in women with acutely life-threatening pelvic infections, Dr. Ronald S. Gibbs said at a conference on obstetrics and gynecology sponsored by the University of Colorado.

"Though we are blessed in the 21st century with multiple antibiotics--and these antibiotics serve us well--the moral of this presentation is that when you're pushed to the wall, the best antibiotic is surgical steel," said Dr. Gibbs, professor and chairman of ob.gyn. at the university.

He focused on four acutely life-threatening infections for which early recognition is essential to get the patient to the operating room for prompt excision of involved tissue:

* Necrotizing fasciitis. Ninety-five percent of ob.gyns. will encounter at least one such case in their careers. In view of that, it would seem this infection gets short shrift.

"In entire 1,300-page textbooks of infectious diseases, there's likely to be about a column and a half on necrotizing fasciitis," Dr. Gibbs observed.

Every medical student knows blackish-blue bullae are a common sign of necrotizing fasciitis. Less well known is that they appear late--usually, too late.

"If you don't make the diagnosis until that point, you have probably missed the opportunity for cure. One of the most characteristic findings of survivorship in necrotizing fasciitis is how quickly you get the patient to the operating room. Those patients who are in the hospital for 48 hours or more before they go to the OR have a significantly higher mortality," he commented.