Abstract
BackgroundThe incidence and mortality from necrotizing fasciitis (NF) are increasing in New Zealand (NZ). Triggered by a media report that traditional Samoan tattooing was causing NF, we conducted a chart review to investigate the role of this and other predisposing and precipitating factors and to document NF microbiology, complications and interventions in NZ.MethodsWe conducted a retrospective review of 299 hospital charts of patients discharged with NF diagnosis codes in eight hospitals in NZ between 2000 and 2006. We documented and compared by ethnicity the prevalence of predisposing and precipitating conditions, bacteria isolated, complications and interventions used.ResultsOut of 299 charts, 247 fulfilled the case definition. NF was most common in elderly males. Diabetes was the most frequent co-morbid condition, followed by obesity. Nearly a quarter of patients were taking non-steroidal anti-inflammatory drugs (NSAID). Traditional Samoan tattooing was an uncommon cause. Streptococcus pyogenes and Staphylococcus aureus were the two commonly isolated bacteria. Methicillin-resistant Staphylococcus aureus was implicated in a relatively small number of cases. Shock, renal failure, coagulation abnormality and multi-organ dysfunction were common complications. More than 90% of patients underwent surgical debridement, 56% were admitted to an intensive care unit (ICU) and slightly less than half of all patients had blood product transfusion. One in six NF cases had amputations and 23.5% died.ConclusionThis chart review found that the highest proportion of NF cases was elderly males with co-morbidities, particularly diabetes and obesity. Tattooing was an uncommon precipitating event. The role of NSAID needs further exploration. NF is a serious disease with severe complications, high case fatality and considerable use of health care resources.
Highlights
The incidence and mortality from necrotizing fasciitis (NF) are increasing in New Zealand (NZ)
Conditions like diabetic gangrene of toe, foot and leg, cellulitis, abscess, plantar fasciitis, Dupuytren’s contracture, and limb loss due to invasive meningococcal disease were sometimes coded as fasciitis or NF
We found that Streptococcus pyogenes, either singly or in combination with a staphylococcus or other organism, was the most frequent organism isolated in NF cases
Summary
The incidence and mortality from necrotizing fasciitis (NF) are increasing in New Zealand (NZ). The disease occurs more frequently in the elderly [4,6,7], diabetics [4,6,7,8,9,10], alcoholics [6,7,8], intravenous drug users [2,4,6,11], in patients with chronic liver disease [2], renal insufficiency [4,7,8], peripheral vascular disease [4,6,7], gout [8,12], underlying malignancy [4,6,7] or immunocompromised states [4,6]. Many NF patients are found to be taking non-steroidal anti-inflammatory drugs (NSAID) at the time of presentation to hospital [9,12,13], but its role remains unclear [14,15]
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