Necrotizing Fasciitis in the Northern Territory of Australia

Abstract

Background: Necrotizing fasciitis (NF), a severe invasive infection of any of the soft tissue compartments of the body, is characterized by fulminant tissue destruction, systemic signs of toxicity and sepsis and high mortality. The aim of the study was to determine the nature of NF in the Northern Territory of Australia. Methods: A retrospective analysis of all cases of NF over a period of 13 years (January 2000 to December 2012) was carried out. Pathological information was obtained from the Laboratory Information System of the Anatomical Pathology Department at Royal Darwin Hospital and patient demographics and clinical outcome data were retrieved from medical records. Results: A total of 85 cases of histologically proven NF cases were available for analysis. The average age was 48 years and the male to female ratio was 1.6:1. Despite the fact that less than one-third of the population of the Northern Territory is indigenous, more than 50% of the NF patients were indigenous and in this group disease mortality rate was 28%, compared to 17% mortality in the non-indigenous group of patients. The lower extremity was the most common site of infection. Group A streptococcus (GAS) was isolated in 45%, Staphylococcus aureus in 20%, pseudomonas species in 4.7%, mixed bacteria in 25.6% and pure fungi in 4.7%. Surgical intervention and antibiotic administration were the standard method of treatment. Amputation was required in 10% of patients. Mortality was high with almost 25% of patients dying from the infection. Conclusion: NF is a devastating infection associated with high morbidity and mortality. Four distinct monomicrobial and one polymicrobial groups emerged. Pure GAS was the commonest offending organism and a distinct albeit small fungal group was also encountered. Clin Infect Immun. 2016;1(1):2-5 doi: http://dx.doi.org/10.14740/cii38e