DOI: http://dx.doi.org/10.18203/2349-2902.isj20184743

Risk factors, microbiological findings and outcomes of necrotizing fasciitis at a tertiary care centre

Divakara S. R., Thrishuli P. B., Bhavuray Teli

Abstract


Background: Necrotizing fasciitis (NF) is a uncommon and serious infection involving the skin and subcutaneous tissues of lower and upper limbs, perineal area (Fournier’s gangrene), and the abdominal wall with high morbidity and mortality. Early diagnosis and aggressive treatment can reduce the mortality rate of NF. The objectives of this study are to study the etiolopathological, microbiological factors determining the outcome of necrotizing fasciitis.

Methods: It is prospective study and was conducted in JSS Medical College and Hospital in October 2008 to October 2010. Total 50 patients diagnosed with necrotizing fasciitis were admitted to JSS Medical College and Hospital. Demographic data, type of co morbidities, site of infection, clinical features with microbiology and laboratory results, and outcomes of patients were analyzed.

Results: Out of 50 patients there were 42 males and 8 females. Highest number of cases was found in the age group of 65-74 years among males, 55-64 years among females. The commonest site in the present study is lower limbs (74%). Diabetes mellitus was the commonest (76%) co morbidity. Beta hemolytic streptococci 22 (44%) was the highest to be isolated. In type I and Coagulase positive staphylococci 18 (36%) was the commonest organism isolated in type II necrotizing fasciitis. The significant risk factors were gender, comorbidties, hospital length of stay, and albumin level, leucocytosis, anemia, hypoalbumenia, low serum ferritin levels increase blood sugar levels. The mortality was 12% (8 patients).

Conclusions: Patients with advance age, co-morbid conditions like diabetes mellitus, hypertension, peripheral vascular disease, osteomyelitis had high unexplained susceptibility to the disease and with a higher incidence in males. Thus, early recognition with a high index of clinical suspicion would definitely reduce both morbidity and mortality. It has gross morbidity and mortality if not treated in its early stages. Leucocytosis, anemia, hypoalbumenia, low serum ferritin levels, increase blood sugar levels were consistent findings seen in majority of the patients which resulted in increased morbidity.


Keywords


Dishwater, Fasciitis, Fournier’s gangrene, Necrotizing fasciitis

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References


Puvanendran R, Huey JCM, Pasupathy S. Necrotizing fasciitis. Canadian Family Physician. 2009;55(10):981-7.

Gregrio DP, Aliffi A, Bollo M, Galvagna S. Necrotizing fasciitis: case reports and review of the literature. Infez Med.1999;7:177-86.

Berlucchi M, Galtelli C, Nassif N, Bondioni MP, Nicolai P. Cervical necrotizing fasciitis with mediastinitis: A rare occurrence in the paediatric age. Am J Otolaryngol. 2007;28:18-21.

Hasham S, Matteucci P, Stanley PRW, Hart NB. Necrotising fasciitis. BMJ. 2005;330:830-3.

Headley AJ. Necrotizing soft tissue infections: a primary care review. Am Fam Physician. 2003;68:323-8.

Taviloglu K, Cabioglu N, Cagatay A, Yanar H, Ertekin C, Baspinar I, et al. Idiopathic necrotizing fasciitis: risk factors and strategies for management. Am Surg. 2005;71:315-20.

Bair M-J, Chi H, Wang W-S, Hsiao Y-C, Chiang R-A, Chang K-Y. Necrotizing fasciitis in southeast Taiwan: clinical features, microbiology, and prognosis. Int J Infect Dis. 2009;13:255-60.

Childers BJ, Potyondy LD, Nachreiner R, Rogers FR, Childers ER, Oberg KC. Necrotizing fasciitis: a fourteen-year retrospective study of 163 consecutive patients. Am Surg. 2002;68:109-16.

File TM, Tan JS, Di Persio. Group A streptococcal necrotizing fasciitis. Diagnosing and treating the “flesh-eating bacteria syndrome” Cleve Clin J Med. 1998;65(5):241-9.

Porter CJW, Simcock JW, MacKinnon CA. Necrotising fasciitis and cellulitis after traditional Samoan tattooing: a case reports. J Infect. 2005;50:149-52.

Salcido RS. Necrotizing fasciitis: reviewing the causes and treatment strategies. Advances in Skin and Wound Care. 2007;20:288-93.

Laucks YES. Gangrene found their way over the verge. Sem Med. 1883;3:345.

Mukhopadhyay M, Saha AK, Biswas RR, Biswas S. A clinicopathological study of necrotizing fasciitis. Al Ame en J Med Sci. 2011;4(1) :6-13.

Shaikh N. Necrotizing fasciitis: A decade of surgical intensive care experience. Indian J Crit Care Med. 2006;10:225-9.

Widjaja AB, Tran A, Cleland H, Leung M, Millar I. The hospital costs of treating necrotizing fasciitis. ANZ J Surg. 2005;75:1059-64.

Voros D, Pissiotis C, Georgantas D, Katsaragakis S, Antoniou S, Papadimitriou J. Role of early and extensive surgery in the treatment of severe necrotizing soft tissue infection. Br J Surg. 1993;80(9):1190-1.

Wilson B. Necrotising fasciitis. Am Surg. 1952;18(4):416-31.

File TM, Tan JS, DiPersio JR. Group A streptococcal necrotizing fasciitis. Diagnosing and treating the “flesh-eating bacteria syndrome” Cleve Clin J Med. 1998;65(5):241-9.

Elliot D, Kufera JA, Myers RA. The microbiology of necrotizing soft tissue infections. Am J Surg. 2000;179(5):361-6.

Seal DV. Necrotizing fasciitis. Curr Opin Infect Dis. 2001;14(2):127-32.

Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003;85A(8):1454-60.

Golger A, Ching S, Goldsmith CH, Pennie RA, Bain JR. Mortality in patients with necrotizing fasciitis. Plast Reconstr Surg. 2007;119(6):1803-7.

Hill MK, Sanders CV. Necrotizing and gangrenous soft tissue infections. In: Sanders CV, Nesbitt LT, editors. The skin and infection: a color atlas and text. Baltimore, MD: Lipincott, Williams and Wilkins; 1995:62-75.

Headley AJ. Necrotizing soft tissue infections: a primary care review. Am Fam Physician. 2003;68(2):323-8.

Hsiao CT, Lin LJ, Shiao CJ, Hsiao KY, Chen IC. Hemorrhagic bullae are not only skin deep. Am J Emerg Med. 2008;26(3):316-9.

Wong CH, Wang TS. What is subacute necrotising fasciitis? A proposed clinical diagnostic criterion. J Infect. 2006;52(6):415-9.

Anaya DA, Dellinger EP. Necrotizing soft tissue infection: diagnosis and management. Clin Infect Dis.2007;44(5):705-10.

Lim YJ, Yong FC, Wong CH, Tan AB. Necrotising fasciitis and traditional medical therapy: a dangerous liaison. Ann Acad Med Singapore. 2006;35(4):270-3.

Jallali N, Withey S, Butler PE. Hyperbaric oxygen as adjuvant therapy in the management of necrotizing fasciitis. Am J Surg. 2005;189(4):462-6.

Frazee BW, Fee C, Lynn J, Wang R, Bostrom A, Hargis C, et al. Community-acquired necrotizing soft tissue infections: a review of 122 cases presenting to a single emergency department over 12 years. J Emerg Med.2008;34(2):139-46.

Miller AT, Saadai P, Greenstein A, Divino CM. Postprocedural necrotizing fasciitis: a 10-year retrospective review. Am Surg. 2008;74(5):405-9.