The impact of necrotizing soft tissue infections on the lives of survivors: a qualitative study

Abstract

Purpose Necrotizing soft tissue infections (NSTI) are potentially lethal infections marked by local tissue destruction and systemic sepsis, which require aggressive treatment. Survivors often face a long recovery trajectory. This study was initiated to increase understanding of the long-term impact of NSTI on health related quality of life (HRQoL), and how care may be improved. Methods Thematic analysis was applied to qualitative data from 25 NSTI-survivors obtained through two focus groups (n = 14) and semi-structured interviews (n = 11). Results The median age of the participants was 49 years, 14 were female. The median time since diagnosis was 5 years. Initial misdiagnosis was common, causing delay to treatment. Survivors experienced long-term physical consequences (scarring, cognitive impairment, fatigue, sleeping problems, recurrent infections), psychological consequences (traumatic stress symptoms, fear of relapse, adjusting to an altered appearance, sexual issues) and social and relational consequences (changes in social contacts, a lack of understanding). The disease also had a major psychological impact on family members, as well as major financial impact in some. There was a strong desire to reflect on ‘mistakes’ in case of initial misdiagnosis. To improve care, patient and family centered care, smooth transitions after discharge, and the availability of understandable information were deemed important. Conclusion This study reveals that NSTI have a large impact on physical and psychosocial wellbeing of survivors and their relatives. Except for a few differences (misdiagnosis, fear for re-infection and actual re-infection), the patient experience of patients with NSTI is largely similar to those of burn survivors. Thus, questionnaires to assess HRQoL in burn survivors may be used in future NSTI studies.

Identification of Potentially Modifiable Factors to Improve Recognition and Outcome of Necrotizing Soft-Tissue Infections

“…In addition to reducing mortality, it is highly relevant to decrease morbidity and improve the long-term quality of life. Morbidity caused by NSTI can be extensive and includes physical (e.g., scars, pain, fatigue), cognitive, psychological, social, and relational consequences (13)(14)(15). Two clinical outcomes measured and analyzed in this study (i.e., the size of the skin defect and amputation of an extremity) reflect physical morbidity.…”

“…Its mortality (mostly due to irreversible septic shock) (2) has decreased over time (3,4) but remains substantial with current reported rates ranging from 10% to 18% (5)(6)(7)(8)(9). In addition, morbidity (due to scars and amputations) can be extensive, with many experiencing prolonged decreased quality of life on physical (9)(10)(11)(12) as well as psychosocial domains (13)(14)(15).…”

Management of Unilateral Buccal Necrotizing Fasciitis Superimposed with Submandibular Abscess At Colli Dextra in a Type 2 Diabetes Mellitus patient : A Case Report

“…Generally, necrotizing fasciitis affects parts of the body such as the extremities, abdomen, and peritoneum. [16] Necrotizing fasciitis that occurs in the head and neck region is generally caused by orofacial infections such as teeth, throat, tonsils, acne, furuncles, or salivary infections.14 Patients receiving long-term diabetes treatment are included in the group that has predisposing factors for the onset of this disease. Commonly accepted predisposing factors include alcoholism, tobacco smoking, immunosuppression, malnutrition, age, malignancy, and liver cirrhosis.…”