Clinicopathological profile and management outcome of skin and soft tissue infections at tertiary care centre of sub Himalayan region

Abstract

INTRODUCTIONHippocrates first described NSTI in the 5 th century BC. He described it as a complication of acute streptococcal infection, writing "many were attacked by the erysipelas all over the body when the exciting cause was a trivial accident flesh, sinews, and bones fell away in large quantities". There were many deaths.1 But first Englishlanguage descriptions of NSTIs were by the British surgeon Leonard Gillespie and British physicians Gilbert Blaine and Thomas Trotter in the late 18 th century. The disease was known as phagedaenic ulcer, gangrenous, gangrenous ulcer, malignant ulcer, putrid ulcer, or hospital gangrene. 2 ABSTRACTBackground: Many times, it is difficult to differentiate between Necrotizing soft tissue infections (NSTI) and Non NSTI based on symptoms, signs and investigations. Only early diagnosis and debridement can prevent high morbidity associated with it. Methods: This prospective observational, study was conducted in the department of General Surgery, over a period of 1 year on consecutive 100 admitted patients. Clinical signs, symptoms and vital parameters of NSTI group and Non NSTI group were compared. Biochemical investigations, systemic involvement and treatment received was also evaluated. Chi-square analysis was performed to compare categorical variables. Results: A 77.8% of the NSTI and 54.7% of the Non NSTI infections occurred in males. Significant difference was found in mean age in patients with NSTI (50.9±13.1) and Non NSTI (41.1±15). Type II DM (38.9%) and hypertension (8.3%) were more commonly associated with NSTI patients. Mean pulse rate, respiratory rate and body temperature were significantly more in NSTI group. Patients with NSTI had significantly less hemoglobin and increased creatinine as compared to Non NSTI group. In NSTI group, 83% of patients had necrotizing fasciitis along with myonecrosis followed by Fournier's gangrene (13.8%). Among Non NSTI group perianal abscess and subcutaneous abscess constituted 45.31% of patients. Methicillin sensitive staphylococcus aureus was found in 43.8% and 38.9% of Non NSTI and NSTI groups respectively. Conclusions: Classical symptoms and signs of NSTI are not reliable and often investigations also fail to differentiate between NSTI and Non NSTI. Type 2 diabetes mellitus patients are more prone to it. High level of clinical suspicion is required for early diagnosis. Timely and adequate debridement of NSTI is necessary to decrease morbidity and mortality.