Outcome Of Necrotizing Fasciitis Research Articles

A prospective study of demographic, clinical profile, treatment of necrotizing fasciitis, and its consequences

Background: The infection that spreads along the fascial planes and causes widespread necrosis is known as necrotizing fasciitis (NF). An uncommon but potentially deadly infectious disease, NF places a significant financial strain on both individuals and the health-care system. There are four occurrences for every 100,000 person-years. Patients with type 1 (polymicrobial) NF are typically immune-compromised, whereas those with type 2 (monomicrobial) NF are typically immune-competent with a trauma history. Type 1 NF has a death rate of 21%, while Type 2 NF has a death rate of 14–34%. Furthermore, NF has the potential to significantly lower patients’ quality of life, especially for those who are having an amputation. Another significant issue for public health is the high death rate. Patients with advanced age, diabetes, smoking, immunosuppression, obesity, malnutrition, steroid therapy, and HIV are more likely to have the disease. Injury and diabetes are important factors. Only few studies have conducted to correlate demographic and clinical features treatment and its outcomes. Therefore, the study is conducted to correlate demographic and clinical features, treatment of NF, and its outcomes. Aims and Objectives: The aims of this study were as follows: (1) to study demographic, clinical profile of patients with NF and (2) to analyze the treatment and outcomes of NF. Materials and Methods: This cohort study was carried out for cases that were clinically diagnosed with NF in patients admitted under the Department of Surgery, Karnataka Institute of Medical Sciences, Hubli, from December 2019 to December 2021. After clearance from the Institutional Ethics Committee, 124 cases were selected based on the inclusion and exclusion criteria. Results: A total of 124 patients were enrolled and analyzed in this study. Most common age group to be affected was 51–60 years. One hundred were male and 24 were female, with male: female ratio of 4.2: 1. Lower limb 95 (76.61%) was the most common site to be involved. Most common risk/precipitating factor for developing NF is trauma 43 (34.65%) followed by diabetes 40 (32.25%). Most common antibiotic used in this study was piperacillin combined with tazobactum in 53 patients (43.54%). Total 124 patients, among them 25 patients underwent amputation, 33 patients were in septic shock and succumbed due to same, 13 patients ended up in skin grafting, the mean duration of hospital stay was 13.46 days, and mean number of debridement was 1.129. Conclusion: In this study, mortality was higher (53.23%), but there was a good improvement in all the surviving patients. Early surgical intervention (within 72 h) with broad spectrum antimicrobials has a favorable outcome. Prompt and early surgical intervention with holistic care helps in reducing morbidity and mortality.

Predictors of mortality in necrotizing fasciitis

Background: Necrotizing fasciitis (NF) is a rapidly progressing life threatening necrosis of the fascia and subcutaneous tissue. This study was done to assess the clinical presentation, laboratory investigations, microbiological characteristics, and major predictors of mortality associated with NF.Material and Methods: A prospective study was conducted from March 2013 to February 2014. NF patients were categorized into two groups based on their in hospital outcome. Demographic data, clinical features, comorbidities, site of infection with microbiology and laboratory results, and surgical intervention for patients were compared and analyzed. SPSS 26.0 statistics software was used for statistical analysis.Results: The mean age was 48.6 ± 16.78 years. Fever (P = 0.0177), tachycardia (P = 0.0155), and septic shock (P = 0.0046) were significantly high in nonsurvivors. Diabetes was the most common comorbidity. Renal impairment (P = 0.0229) was significantly high in the nonsurvivor group. The most common site was lower limb/thigh NF. Abdomen/groin NF (P = 0.0158) was significantly high in nonsurvivors. Nonsurvivors had significantly low hemoglobin (P = 0.0027) and serum sodium (P = 0.0023) and had significantly high leukocyte count (P = 0.00001), serum creatinine (P = 0.0000), serum glucose (P = 0.00003), and LRINEC score (P = 0.00002). Polybacterial infections (P = 0.021) were significantly high in nonsurvivors. The frequency of debridement more than 2 (P = 0.0469) and debridement within 24 h of admission (0.0013) were significantly high in survivors. Hospital stay (P = 0.0272) was significantly high in nonsurvivors. Multivariate logistic regression analysis did not show any independent factors associated with mortalityConclusion: Identification of predictors of mortality can improve the management and outcome of NF.

Mortality Risk in Necrotizing Fasciitis: National Prevalence, Trend, and Burden.

Background: Necrotizing fasciitis (NF) is a fulminant, life-threating infection of fascia and subcutaneous tissue. Because of the low incidence, previous studies were statistically underpowered to assess factors associated with the risk of mortality. The aim of this study is to identify the risk factors associated with mortality in this select group of patients. Methods: A retrospective cross-sectional study was performed utilizing the Nationwide Readmissions Database, 2010-2014. The database captures 56.6% of all U.S. annual hospitalizations. Study population included inpatients admitted emergently with NF. Results: A total of 4,178 cases were included, of which 2,061(48.9%) patients had a history of diabetes mellitus (DM). The most common presentation was septicemia (39.5%) and 9.2% were admitted initially as cellulitis/abscess. Overall mortality risk was 12.6% with no substantial change in the annual trend. Mortality in patients with diabetes was substantially lower (8.5% vs. 16.5%, odds ratio [OR]: 0.44, 95% confidence interval [CI] = [0.34, 0.56], p < 0.001). Factors associated with a higher mortality risk included: older age, chronic liver diseases, disseminated intravascular coagulopathy, septic shock, pulmonary complications, acute renal failure, and not undergoing surgical intervention (p < 0.05 each). Patients who did not undergo surgical debridement were more likely to be ≥65 years of age and have multiple comorbidities. Hyperbaric oxygen therapy and intravenous immunoglobulin were used in 1.3% and 0.3% of the sample, respectively, with no reported use among patients who died. Conclusions: This study provides a new and updated perspective on the prevalence, trend, and outcomes of NF in the United States. Necrotizing fasciitis is associated with septicemia and lack of surgical intervention is associated with a higher mortality.

Etiology, characteristics, and outcomes of community-onset necrotizing fasciitis in Korea: A multicenter study.

BackgroundNecrotizing fasciitis (NF) is a serious skin and soft tissue infection causing high mortality. Investigating region specific epidemiologic factors associated with NF is important for establishing appropriate treatment strategies. This multicenter study was done to provide an update of the microbial etiology, clinical characteristics, and outcomes of NF in Korea.Materials and methodsA retrospective cohort of adult patients with NF was established using patient data from 13 general hospitals between January 2012 and December 2015 in Korea. We evaluated microbial etiology and clinical characteristics to identify risk factors associated with in-hospital mortality; analyses were performed using binary logistic regression models.ResultsA total of 161 patients with NF were included. The most common underlying disease was diabetes mellitus (66 cases, 41.0%). A total of 148 organisms were isolated from 119 (73.9%) patients. Enteric Gram-negative organisms (36 patients) were the most common pathogen, followed by Staphylococcus aureus (30 patients) and streptococci (28 patients). Methicillin-resistant Staphylococcus aureus (MRSA) was identified in 6.2% (10/161) of patients. Of 37 enteric Gram-negative isolates tested, 26 (70.3%) isolates were susceptible to ceftriaxone. The in-hospital mortality rate was 22.4%. Intensive care unit admission, septic shock, and Gram-negative organism infections were significantly associated with in-hospital mortality, and surgery was not a favorable prognostic factor.ConclusionsAs initial empirical antibiotics, glycopeptides against MRSA and broad-spectrum antibiotics against third-generation cephalosporin-resistant organisms should be considered for patients with community-onset NF in Korea.

Necrotizing Fasciitis Among Patients With Liver Cirrhosis in Texas, 2001 - 2010: A Population-Based Cohort Study.

BackgroundLiver cirrhosis is a risk factor for necrotizing fasciitis (NF), and is associated with markedly worse outcomes than for NF among non-cirrhosis patients. Only limited, mostly single-center, data were reported to date on the epidemiology, clinical features, resource utilization and outcomes of NF among patients with cirrhosis.MethodsWe studied a population-based cohort of adult hospitalizations associated with cirrhosis, who had a diagnosis of NF during the years 2001 - 2010, using the Texas Inpatient Public Use Data File. The annual volume of NF hospitalizations was benchmarked against all annual hospitalizations with a diagnosis of cirrhosis. The patterns of demographics, chronic comorbidities, evolving organ failure, resource utilization and outcomes were examined.ResultsThere were 371,745 hospitalizations associated with liver cirrhosis, with 381 NF hospitalizations during study period. The annual volume of NF hospitalizations rose 7.9%/year (P = 0.0287), while its incidence among cirrhosis-associated hospitalizations remained unchanged (P = 0.2955). Non-cirrhosis comorbidities were reported in 69.6% and ICU care was required in 67.2% of NF hospitalization. The key changes noted between 2001 - 2003 and 2008 - 2010 among NF hospitalizations included rising mean (SD) Deyo-Charlson index 2.4 (1.5) vs. 3.9 (2.4) (P < 0.0001), development of ≥ 3 organ failures in 9.1% vs. 39.8% (P < 0.0001), and discharge to long-term care facilities 7.8% vs. 21.1% (P = 0.0204). Hospital mortality was unchanged (26% vs. 33.1%; P = 0.3659). Inflation-adjusted total hospital charges did not change (P = 0.1025) during study period.ConclusionsThe present cohort of NF associated with liver cirrhosis is the largest reported to date. A rising annual volume of NF events matched a corresponding increase in cirrhosis-associated hospitalizations. There was increasing burden of chronic comorbidity and rising severity of illness, with a majority of patients requiring ICU care. Case fatality was high and there has been increasing residual morbidity among hospital survivors. The observed findings warrant further study in other populations.

Necrotizing Fasciitis of the Upper and Lower Limbs: Port Harcourt Experience

Background: Necrotizing fasciitis (NF) is a rare but life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the fascial planes and surrounding tissue. Aim: To determine the clinical characteristics at presentation, causative pathogens and clinical outcome of NF after aggressive management. Patients and methods: We retrospectively reviewed case notes of patients with NF referred to the Teaching Hospital in Port Harcourt from January 2004 to December 2009. Results: The case notes of over 2,280 patients with history of cellulitis and/or infections of the upper and lower limbs were reviewed. These cases were seen in a five-year period from 2004 to 2009. Seventy five (3.29%) patients had a diagnosis of necrotizing fasciitis and were evaluated. Only those with infections on the lower and upper limbs were further analyzed. Thirty five (46.67%) patients had their infections in the lower limb while 40 (53.33%) patients had their infections in the upper limb. Twenty (26.67%) patients were found to be diabetic on admission. Thirty (30%) patients sustained injuries on their limbs while 5 (6.67%) patients could not give account of their infections. Eleven (14.66%) patients had fixed flexion deformities as their wounds healed and had to have further plastic surgery to extend their limbs and 7 (9.33%) patients died while on admission. Conclusion: Although an early diagnosis of NF can be difficult, a high index of suspicion is required in all patients presenting with unexplained warmth and/or cellulitis of the limbs, so that prompt and aggressive debridement can be carried out with commencement of broad spectrum antibiotics.

Necrotizing fasciitis in adolescents with poorly controlled type 1 diabetes mellitus: report of two cases

Necrotizing fasciitis (NF) is a potentially fatal bacterial infection of the subcutaneous soft tissues. Two cases of polymicrobial NF in adolescents with type 1 diabetes mellitus and poor glycemic control are reported. The perineal region was involved in both cases. One case was precipitated by apparently minimal trauma, the other by high-impact trauma. Diabetes mellitus has been identified as a common comorbidity and predictor of increased mortality in adult patients with NF. The associations between diabetes and the incidence or outcome of NF in children and adolescents are not known. In all cases, early identification and aggressive surgical intervention are important for limiting morbidity and mortality.