Necrotizing fasciitis: a tertiary centre based study

Abstract

Background: Necrotizing fasciitis is a limb or life-threatening, invasive soft-tissue infection, although known since ancient times was first described in 1871. The purpose of the present study is to analyze the clinical presentation, bacterial flora, predisposing and co-morbid conditions, surgical and resuscitative treatment and outcome of this soft tissue infection.Methods: This is a prospective, cross-sectional, clinical study which was conducted from May 2016 until April 2018. This study included 60 consecutive patients. Age, gender, clinical presentation, co-morbid conditions and predisposing factors and pus culture sensitivity, treatment given, and its outcome were recorded.Results: With a male female ratio of 2.33:1 and median age of 46, most involves site was lower limb. Most patients presented with history of trauma followed by swelling (100%), pain (91.67%), and pus discharge (48.33%). Group A streptococcus was the most common organism isolated in both monomicrobial (53.85%) and polymicrobial (63.83%) cultures. Diabetes was the most common co morbidity observed. Fasciotomy and debridement were the mainstay of treatment with amputation rate of 23.33% and a mortality of 25%.Conclusions: Timely surgical intervention in the form of fasciotomy and debridement along with correction of malnutrition and anemia can be crucial in saving lives and limbs.

Laboratory risk indicator for necrotising fasciitis [LRINEC] score as a tool for differentiating necrotising fasciitis from other soft tissue infections

“…In the present study, the most common site of NF infection was extremities followed by scrotum and perineum which was in accordance with a study by Singh et al The study reported most common anatomical sites with NF was lower extremities, followed by the upper extremity, and perineum (18). A prospective, cross sectional study also showed lower extremity, followed by upper extremity, and other sites such as perineum, chest, buttocks as the most common anatomical sites infected (5).…”

“…The most pre-disposing factors observed from this study group were age, DM, and hypertension, which was in par with other reported studies (5,(18)(19)(20). In patients with DM, a delay in diagnosis of NF was apparent, especially in early stages.…”

“…In a recent retrospective study by Rampal et al, 60% of patients were male (15). Many reported studies showed the male predominance with highest number of cases among age groups between 50 and 60 years (5,12,(15)(16)(17).…”

“…Once the pathogens enter the subcutaneous tissues, the pathogens releases exotoxins causing tissue necrosis. Patients with co-morbidities such as diabetes mellitus (DM), peripheral vascular diseases, malnutrition, liver disease, kidney disease, human immunodeficiency virus, and alcohol abuse were reported to be more susceptible to the disease (5).…”

Treating necrotizing fasciitis patients at the topmost referral hospital in West Java, Indonesia: 6 years experience

“…The other studies, such as Divakara et al, stated that the mortality rate in their study was 12% 7 . Ekka et al found a higher mortality rate 4 . They observed 25% of mortality rate.…”