BACKGROUND: Necrotizing soft tissue infection is one of the most severe life-threatening surgical infections with a very high mortality rate. A characteristic feature of necrotizing soft tissue infection is the rapid development of anemia, the causes and prognostic value of which are not well understood. AIM: The purpose of this study was to investigate the timing, development, and dynamics of anemia in generalized forms of necrotizing infection to identify clinical and bacteriological factors associated with its development. MATERIALS AND METHODS: 129 patients with necrotizing soft tissue infection who were treated from 09.2015 to 12.2019 in the department of purulent-septic surgery at Hospital of the Holy Great Martyr George were examined. All patients received surgical treatment, laboratory hematological, biochemical examination, bacteriological examination of blood, and wound discharge. Overall, 22 patients suffered from systemic inflammatory response syndrome, 63 patients with sepsis, and 41 patients with septic shock. RESULTS: The Counts of hemoglobin and red blood cells in necrotizing soft tissue infection patients with sepsis revealed the anemia already during the first day and then from the 15th day of the disease, the red blood cell values began to rise in the patients who survived. However, continued to decrease in the deceased patients. In the group of deceased sepsis patients from day 3 of hospitalization, correlations between red blood cells count and potassium ion concentration (r = 0.318; p 0.01), and red blood cells count and total plasma protein (r = 0.30; p 0.01) became significant. Among patients with hemoglobin 110 g/L on the day of hospitalization, 36 of 67 (53.7%) patients died, and among those with hemoglobin levels 110 g/L, 20 of 62 (32.2%) patients died (p = 0.004). The highest lethality was registered patients who suffered from wound discharge Klebsiella pneumoniae (12 of 18, 66.7%) or anaerobic infection, but marked anemia was noted only in patients with anaerobic infection (Proteus spp., Clostridium spp., Bacteroide spp.) (8 out of 12, 66.7%). CONCLUSIONS: We attribute the development of anemia in sepsis patients to the destruction of red blood cells. The type of infectious agent influences both the mortality rate and the degree of anemia, which is probably related to the ability of bacteria to destroy red blood cells.

Necrotizing soft tissue infection (NSTI) is a severe surgical infection which can result in sepsis and septic shock when generalized.The aim of the study was to determine the frequency of thrombocytopenia in patients with generalized NSTI, the factors promoting its development, and its association with septic shock.Materials and Methods. We examined 129 patients with NSTI treated between 09.2015 and 12.2019 at St. George Hospital in St. Petersburg, Russia. Surgical treatment, hematological and biochemical examinations, and bacteriological analysis of blood and wound discharge were performed in each patient. The studied group included 22 patients with systemic inflammatory reaction syndrome, 63 patients with sepsis, and 44 patients with septic shock.Results. We found a decrease in platelet count in NSTI patients with septic shock as early as on the first day of the disease and its further decrease within the next 3 days, with the mean platelet volume (MPV) increasing during the same period and significantly exceeding that in patients with sepsis and systemic inflammatory response syndrome. In NSTI patients with thrombocytopenia on admission, we found a significant correlation between the platelet count and the percentage of segmented neutrophils (r=0.349; P<0.001; n=40). The maximum incidenсe of septic shock was observed in patients infected with Klebsiella pneumoniae (13 out of 19, 65%). These patients had the highest MPV but did not develop thrombocytopenia. Maximum frequency of thrombocytopenia and elevation of MPV and platelet distribution width (PDW) was found in patients with NSTI and underlying chronic viral hepatitis C. However, the relative frequency of septic shock in these patients was not increased.Conclusion. The development of septic shock in NSTI is associated with a specific platelet activation pattern

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