A prospective study of demographic, clinical profile, treatment of necrotizing fasciitis, and its consequences

Abstract

Background: The infection that spreads along the fascial planes and causes widespread necrosis is known as necrotizing fasciitis (NF). An uncommon but potentially deadly infectious disease, NF places a significant financial strain on both individuals and the health-care system. There are four occurrences for every 100,000 person-years. Patients with type 1 (polymicrobial) NF are typically immune-compromised, whereas those with type 2 (monomicrobial) NF are typically immune-competent with a trauma history. Type 1 NF has a death rate of 21%, while Type 2 NF has a death rate of 14–34%. Furthermore, NF has the potential to significantly lower patients’ quality of life, especially for those who are having an amputation. Another significant issue for public health is the high death rate. Patients with advanced age, diabetes, smoking, immunosuppression, obesity, malnutrition, steroid therapy, and HIV are more likely to have the disease. Injury and diabetes are important factors. Only few studies have conducted to correlate demographic and clinical features treatment and its outcomes. Therefore, the study is conducted to correlate demographic and clinical features, treatment of NF, and its outcomes. Aims and Objectives: The aims of this study were as follows: (1) to study demographic, clinical profile of patients with NF and (2) to analyze the treatment and outcomes of NF. Materials and Methods: This cohort study was carried out for cases that were clinically diagnosed with NF in patients admitted under the Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, from December 2019 to December 2021. After clearance from the Institutional Ethics Committee, 124 cases were selected based on the inclusion and exclusion criteria. Results: A total of 124 patients were enrolled and analyzed in this study. Most common age group to be affected was 51–60 years. One hundred were male and 24 were female, with male: female ratio of 4.2: 1. Lower limb 95 (76.61%) was the most common site to be involved. Most common risk/precipitating factor for developing NF is trauma 43 (34.65%) followed by diabetes 40 (32.25%). Most common antibiotic used in this study was piperacillin combined with tazobactum in 53 patients (43.54%). Total 124 patients, among them 25 patients underwent amputation, 33 patients were in septic shock and succumbed due to same, 13 patients ended up in skin grafting, the mean duration of hospital stay was 13.46 days, and mean number of debridement was 1.129. Conclusion: In this study, mortality was higher (53.23%), but there was a good improvement in all the surviving patients. Early surgical intervention (within 72 h) with broad spectrum antimicrobials has a favorable outcome. Prompt and early surgical intervention with holistic care helps in reducing morbidity and mortality.