Abstract
Background: Necrotizing fasciitis is a serious infection of skin and soft tissues that rapidly progresses along the deep fascia. It’s a fatal infection with high mortality if treatment delayed. Early diagnosis, surgical debridement and broad-spectrum antibiotic therapy are the optimal treatments to reduce the mortality. Objective: The aims were to identify risk factors for Necrotizing fasciitis and to describe the outcome of management. Methods: A prospective descriptive study was conduted at AL-THAWRA HOSIPTAL located in Sana’a, Yemen. All medical records of patients with confirmed NF who admitted to surgical department between January 2020 and January 2021 were reviewed. Results: The study enrolled 54 patients diagnosed with Necrotizing fasciitis. Male patients were 43 patients (79.6%) and female patients were 11 patients (20.3%). The age rang was 9 – 75 years old and the peak age incidence was at 46–60 years (33.3%). The incidence of NF increases with aging, male gander (79.6%), in comorbid patients (64.9%) especially DM (37%). The etiologies of NF were trauma in (16.6%) and perianal abscess in (14.8%), but (27.7%) of NF patients hadn’t specific cause. The defected wound was treated by skin graft in (32.5%) and primary closure in (27.5%). The mortality rate was (27.7% n=15); (60%) of them died on first 5 days. Septic shock was the reason of death in (73.2%). The higher mortality rate was seen at male gander (66.6%), age group > 60 years (46.6%), in patients who presented in shocked state (73.3%) and in comorbid patients (73.3%). Conclusion: Necrotizing fasciitis represents a life threatening condition with challenges in diagnosis. Incidence and mortality of NF are common in male gander, an elderly patient, or in who suffers of comorbidities; especially DM.
Highlights
Necrotizing fasciitis, which commonly known as flesh-eating disease, is characterized by angiothrombotic microbial invasion and liquefactive necrosis, [1] that lead to develop of Progressive necrosis of the superficial fascia, deep dermis and fascia that infiltrated by polymorphonuclear leukocytes, with thrombosis of nutrient vessels and occasional suppuration of the veins and arteries; bacteria proliferate within the destroyed fascia. its incidence has been varyingly reported worldwide, 0.4 cases per 100, 000 populations in Canada [2] and 1.3 cases per 100, 000 populations in Florida, USA [3]
We aim to study the predisposing Factors, management and outcomes of Necrotizing Fascitis in patients who admitted to surgical department at AL-Thawra Modern General Hospital (AMGH) from January 2020 to January 2021 and to evaluate the Laboratory tests and their relation with Necrotizing Fascitis and the prognostic value of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score in Necrotizing Fascitis patients
Our study enrolled 54 patients diagnosed with Necrotizing Fascitis that reveals the incidence of Necrotizing Fascitis was more in male gander (79.6%) with male to female ratio was 4: 1, in normal active patients (62.9%) and in rural patients (59.3%) and Peak incidence was at Age group 46 - 60 years old (33.3%) with mean age was 45.07 ± 15.7 years, and range was 9 – 75 years
Summary
Necrotizing fasciitis, which commonly known as flesh-eating disease, is characterized by angiothrombotic microbial invasion and liquefactive necrosis, [1] that lead to develop of Progressive necrosis of the superficial fascia, deep dermis and fascia that infiltrated by polymorphonuclear leukocytes, with thrombosis of nutrient vessels and occasional suppuration of the veins and arteries; bacteria proliferate within the destroyed fascia. its incidence has been varyingly reported worldwide, 0.4 cases per 100, 000 populations in Canada [2] and 1.3 cases per 100, 000 populations in Florida, USA [3]. In Asia, consumption of raw or undercooked seafood or injury by fish fins can lead to NF [5] In this group of infections, bacteria such as Vibrio spp., Aeromonas spp., and Shewanella spp. are commonly involved and are usually known as “marine bacteria” [6] The most frequent comorbidity in NF patients is DM. Results: The study enrolled 54 patients diagnosed with Necrotizing fasciitis. The incidence of NF increases with aging, male gander (79.6%), in comorbid patients (64.9%) especially DM (37%). The higher mortality rate was seen at male gander (66.6%), age group > 60 years (46.6%), in patients who presented in shocked state (73.3%) and in comorbid patients (73.3%). Incidence and mortality of NF are common in male gander, an elderly patient, or in who suffers of comorbidities; especially DM
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