Severe necrotizing fasciitis in PICU

Abstract

Objective To investigate the clinical characteristics, diagnosis and treatment of necrotizing fasciitis (NF). Methods The authors reviewed and analyzed clinical manifestations, auxiliary examinations, treatments and prognoses of 14 patients who had been diagnosed with NF and hospitalized in the Children′s Hospital of Anhui province between Jan 2007 and Sep 2013. Results Among the patients included in this study, eight cases were male and six cases were female.The average age was (15.86±10.48) month, The time of abnormal temperature was (10.64±5.64) d, hospital day was (29.07±16.30) d, numbers of debridements were (3.07±1.33) times.All patients had septic shock in which 5 cases had multiple organ failure.Diseases were found on hips (5 cases), lower limbs (4 cases), back (2 cases), perineum (2 cases), and neck (1 case). Blood culture showed staphylococcus aureus in six cases (1 case of methicillin-resistant staphylococcus aureus), pseudomonas aeruginosa in four cases and angina group of streptococcus pneumoniae in one case.No obvious bacteria growth was observed in three cases.CT examinations reflected subcutaneous gas formation in 11 cases but skin and subcutaneous tissue edema and fascial thickening in all cases.All cases of NF were further confirmed with soft tissue biopsies.Early symptoms resembled those of cellulitis.As the diseases progressed, other symptoms appeared such as skin ulceration, bullae formation and gas formation in the tissues.All patients were treated with surgical debridements (vacuum sealing drainage continuous drainage in 5 cases), appropriate antibiotic coverage and colloid supporting treatments.Seven patients were healed (50.00%, 7/14), four had skin grafts (28.57%, 4/14) and 3 died(21.43%, 3/14). Six cases were found having limited physical activities in two year follow-up visits. Conclusion NF is a rare but potentially fatal disease.It is commonly found on the perineum, abdominal wall and extremities.NF can easily lead to septic shock and multiple organ failure.Early detection, surgical debridement and proper drainage along with appropriate antibiotic coverage can decrease mortality rates. Key words: Necrotizing fasciitis; Soft tissue infection; Debridement