Epidemiological, Clinical and Therapeutic Features of Bacterial Dermohypodermatitis and Necrotizing Fasciitis in a Municipality of Northern Benin

Abstract

Background: Dermohypodermatitis is an infectious skin disease affecting dermis and hypodermis, often caused by bacteria. In Benin, these infections are frequent in the northern region, especially in Atacora municipality. Objective: The current study aims to investigate through a multicenter data collection, the epidemiological, clinical and therapeutic features of bacterial dermohypodermatitis and necrotizing fasciitis in Atacora prefecturemunicipality in Benin. Method: This was a prospective cross-sectional study with descriptive and analytical purposes carried out from February to July 2021 (six months) in the general surgery services of three hospitals in Atacora municipality. Patients were at least 15 years old and diagnosed for non-necrotizing dermohypodermatitis, necrotizing dermohypodermatitis or necrotizing fasciitis. Results: A total of 48 cases of dermohypodermatitis were recorded throughout the study period. The mean age of the patients was 36 ± 13 years. The sex-ratio (male-out of-female) was 1.4. Farmers accounted for 43.75% of the cases. The median time from the symptoms onset to patient admission into a health care center was 14 days. A disease entry was found in 81.25% of cases, dominated by neglected traumatic wounds (72.92%). The pelvic limb was the most affected (89.58%). Necrotizing forms predominated in two-thirds of the cases (66.67%). The mean LRINEC score was 6 ± 1.08. The common bacteria isolated after swabbing were: Staphylococcus aureus, Pseudomonas aeruginosa, Peptostreptococcus anaerobius, Streptococcus pyogenes, Proteus mirabilis and Escherichia coli. Surgical excision of necrotic tissue was performed in 68.75% of patients with a necrotizing form and 40.62% of them have undergone a thin skin grafting afterwards. The hospital stay averaged 36 days [minimum and maximum, 4 and 139 days, respectively]. Mortality rate was 4.17% and sequelae, 9.76%. NSAIDs use (p=0.000), traditional treatment prior to admission into a health care center .....