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

Abstract

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.

Recurrent Necrotizing Fasciitis: A Case Report of Fulminant and Sub-Acute Necrotizing Fasciitis in a Diabetic Patient

“…This allows entry of the offending organism(s). NSTI may be polymicrobial or monomicrobial in nature [1,2,14]. The infection moves through the deeper layers of the soft tissues, along the fascial planes, hence given the name of necrotizing fasciitis, a vigorous immune response subsequently occurs with extensive neutrophil rich inflammation [15].…”

“…Diabetes mellitus is a risk factor in up to 70% of all NSTI patients, including the Fournier's gangrene subtype [2,4,5,8,9,[11][12][13][14][15][16][17][18]. Additional commonly described risk factors include increasing age, chronic liver disease, chronic kidney disease, obesity, immunosuppression, underlying malignancy, and poor hygiene [5,10,12,16].…”

“…The literature consensus for management of all NSTI is centred on resuscitation of the patient to minimise end-organ damage, broad-spectrum antibiotics, and immediate, radical resection of affected tissue [1][2][3][4][5]8,9,[11][12][13][14][15][16][17][18]. Time to surgery is often described as the most important determinant for reducing mortality and morbidity [5,[12][13][14][15].…”

“…This in conjunction with the length of hospital stay demonstrates the severity of the disease. Many authors describe the need for radical resection as being judicious, and attempting to conserve tissue may result in poorer outcomes [1][2][3]5,[8][9][10][11][12][14][15][16][17][18].…”

“…Necrotizing soft tissue infection (NSTI), also known as necrotizing fasciitis, is an uncommon disease entity that is characterised by rapidly progressing skin and soft tissue destruction [1,2] with a high mortality rate. Early radical surgical resection of infected tissue coupled with broad-spectrum antibiotic coverage and systemic support for sepsis are imperative to improve survival [1][2][3]. It is proposed that NSTIs [4][5][6][7] exist on a continuum and range from subacute to hyperacute fulminant infections.…”