Mortality from necrotizing fasciitis: a cross-sectional study

Authors

  • Patric Paul Department of Plastic Surgery, Government Medical College, Trivandrum, Kerala, India
  • Induprabhayadev Prabhakaran Department of Surgery, Government Medical College, Trivandrum, Kerala, India
  • Meer Chisthi Department of Surgery, Government Medical College, Trivandrum, Kerala, India

DOI:

https://doi.org/10.18203/2349-2902.isj20201036

Keywords:

Diabetes mellitus, Fournier’s gangrene, Mortality, Morbidity, Necrotizing fasciitis

Abstract

Background: Necrotizing fasciitis refers to the rapidly progressive inflammation of the fascia, with secondary necrosis of subcutaneous tissues. Due to the high mortality, it is considered a surgical emergency, needing timely diagnosis and appropriate treatment with early debridement. The aim of the study was to analyse the clinical profile of patients with necrotizing fasciitis so as to determine the mortality and the risk factors associated with mortality and other poor outcomes.

Methods: This retrospective cross-sectional study was conducted in a tertiary hospital in Kerala, from January 2016 through January 2018. 175 cases were identified through the ICD codes for necrotizing fasciitis and Fournier’s gangrene in the discharge and death registers; and data were obtained about these patients. The data were analyzed to assess the study objectives.

Results: In this study mortality was found to be 22.7%. Diabetes mellitus was found to be the most common co-morbid disease and had a significant association with increased risk of amputation. Mixed growth (type I NF) was the most common microbiological isolate and Pseudomonas was the most common gram-negative isolate. 4 cases of MRSA were recorded. Klebsiella infection was found to have increased risk of undergoing limb amputation. 7.4% of the patients required amputation during hospital stay for infection control.

Conclusions: Necrotizing fasciitis has a high mortality. Diabetes mellitus was found to be the most common co-morbid disease. Increased blood glucose and low serum albumin had a significant association with an increased risk of amputation. Proper control of these factors is essential to reduce mortality from this condition.

References

Wilson B. Necrotizing fasciitis. Am J Surg. 1952;18:416-31.

Bilton BD, Zibari GB, McMillan RW, Aultman DF. Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study/discussion. Am Surg. 1998;64(5):397.

Sartelli M, Malangoni MA, May AK, Viale P, Kao LS, Catena F, et al. World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections. World J Emerg Surg. 2014;9(1):57.

Giuliano A, Lewis F, Hadley K, Blaisdell FW. Bacteriology of necrotizing fasciitis. Am J Surg. 1977;134(1):52-7.

Morgan MS. Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hospital Infec. 2010;75(4):249-57.

King MD, Humphrey BJ, Wang YF, Kourbatova EV, Ray SM, Blumberg HM. Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med. 2006;144(5):309-17.

Plumblee L, Grey H, Hudspeth M, Nadig S. Undifferentiated embryonal sarcoma and the role of liver transplantation. J Pediatr Surg Case Rep. 2019;49:101284.

Ho SW, Ang CL, Ding CS, Barkham T, Teoh LC. Necrotizing Fasciitis Caused by Cryptococcus gattii. Am J Orthoped (Belle Mead, NJ). 2015;44(12):E517-22.

Jain D, Kumar Y, Vasishta RK, Rajesh L, Pattari SK, Chakrabarti A. Zygomycotic necrotizing fasciitis in immunocompetent patients: a series of 18 cases. Modern Pathol. 2006;19(9):1221.

Wang JM, Lim HK. Necrotizing fasciitis: eight-year experience and literature review. Brazilian J Infec Dis. 2014;18(2):137-43.

Family B. Necrotizing Fasciitis. Adult-Gerontology Acute Care Pract Guidelines. 2019: 217.

Hietbrink F, Bode LG, Riddez L, Leenen LP, van Dijk MR. Triple diagnostics for early detection of ambivalent necrotizing fasciitis. World J Emerg Surg. 2016;11(1):51.

Hsiao CT, Weng HH, Yuan YD, Chen CT, Chen IC. Predictors of mortality in patients with necrotizing fasciitis. Am J Emerg Med. 2008;26(2):170-5.

Kwan MK, Saw A, Chee EK, Lee CS, Lim CH, Zulkifle NA, et al. Necrotizing fasciitis of the lower limb: an outcome study of surgical treatment. Med J Malaysia. 2006;61:17-20.

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

Singh G, Sinha SK, Adhikary S, Babu KS, Ray P, Khanna SK. Necrotising infections of soft tissues-a clinical profile. Eur J Surg. 2002;168(6):366-71.

Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Annal Surg. 1996;224(5):672.

Kulasegaran S, Cribb B, Vandal AC, McBride S, Holland D, MacCormick AD. Necrotizing fasciitis: 11‐year retrospective case review in South A uckland. ANZ J Surg. 2016;86(10):826-30.

Gupta Y, Chhetry M, Pathak KR, Jha RK, Ghimire N, Mishra BN, et al. Risk factors for necrotizing fasciitis and its outcome at a tertiary care centre. J Ayub Med Coll Abbottabad. 2016;28(4):680-2.

Anaya DA, Bulger EM, Kwon YS, Kao LS, Evans H, Nathens AB. Predicting death in necrotizing soft tissue infections: a clinical score. Surg Infec. 2009;10(6):517-22.

Espandar R, Sibdari SY, Rafiee E, Yazdanian S. Necrotizing fasciitis of the extremities: a prospective study. Strategies Trauma Limb Reconstruct. 2011;6(3):121-5.

Yu SN, Kim TH, Lee EJ, Choo EJ, Jeon MH, Jung YG, et al. Necrotizing fasciitis in three university hospitals in Korea: a change in causative microorganisms and risk factors of mortality during the last decade. Infec Chem. 2013;45(4):387-93.

Salvador VB, San Juan MD, Salisi JA, Consunji RJ. Clinical and microbiological spectrum of necrotizing fasciitis in surgical patients at a Philippine university medical centre. Asian J Surg. 2010;33(1):51-8.

Yim SU, Kim SW, Ahn JH, Cho YH, Chung H, Hwang EC, et al. Neutrophil to lymphocyte and platelet to lymphocyte ratios are more effective than the fournier's gangrene severity index for predicting poor prognosis in fournier's gangrene. Surg Infec. 2016;17(2):217-23.

Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535-41.

Bozkurt O, Sen V, Demir O, Esen A. Evaluation of the utility of different scoring systems (FGSI, LRINEC and NLR) in the management of Fournier’s gangrene. Inter Urol Nephrol. 2015;47(2):243-8.

van Loon K, van Zaane B, Bosch EJ, Kalkman CJ, Peelen LM. Non-invasive continuous respiratory monitoring on general hospital wards: a systematic review. PLoS One. 2015;10(12):e0132775.

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Published

2020-03-26

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Original Research Articles