Necrotizing Fasciitis: Risk Factors and Outcomes in the COVID-19 Era

Abstract

Background: Necrotizing Fasciitis is a severe, rapidly spreading soft tissue infection with high morbidity and mortality. Diabetes mellitus, hypertension, and immune suppression are the some of the predisposing factors for the disease. The objective of this study was to study the risk factors and outcomes of necrotizing fasciitis in the COVID-19 era. Methods and Materials: a retrospective analysis of the data of forty-four patients admitted with the diagnosis of NF from April 2020 to April 2021was done at Dr Ram Manohar Lohia Hospital, New Delhi. Data was recorded in MS Excel spreadsheet program. SPSS v23 (IBM Corp.) was used for data analysis. Descriptive statistics were elaborated in the form of means/standard deviations and medians/IQRs for continuous variables, and frequencies and percentages for categorical variables. Chi-square test (X2) was used for group comparisons of categorical data. Results: Out of forty-four patients, 26 (59.10%) were male and 18 (40.9%) were female. The mean age was 54.2 years (+ 14.4 years). Extremities (68.2%) were the most commonly involved site followed by perineum (29.5%) and abdominal wall (2.2%). Diabetes mellitus (DM) was the most prevalent comorbidity. 10 patients had both DM and hypertension (HTN). Fourteen patients (32%) had a polymicrobial infection on tissue culture. Rest thirty patients had involvement of gram positive (44%) and gram negative (24%) organisms. Twenty-two patients (50%) had healthy granulation tissue as the final outcome. However, the rest 50% patients had a poor outcome in form of amputation (13.63%) and mortality (36.36%). Average duration from onset of symptoms to presentation at the hospital was 7.11 (+ 3.47) days. Patients who presented early to the hospital within 7 days of symptom onset had a good outcome in the form of healthy granulation tissue (X2= 7.62 and p <0.05). Conclusions: Early diagnosis and prompt surgical intervention in necrotizing fasciitis is the key to its management. Delayed presentation was because of restricted movement, government-imposed lockdowns, patients ignoring their symptoms, and resorting to self-medications. The delay in diagnosis leading to a delay in treatment is one of the major factors contributing to poor outcomes in the COVID-19 era. Keywords: necrotizing fasciitis, risk factors, COVID 19.