Necrotising fasciitis in the North East of Scotland: a 10-year retrospective review

Abstract

Introduction Necrotising fasciitis is a life-threatening rapidly progressing bacterial infection of the skin requiring prompt diagnosis and treatment. Optimum care warrants a combination of surgical debridement, antibiotics and intensive care support. All cases of necrotising fasciitis in 10 years in the North East of Scotland were reviewed to investigate and improve patient care. Methods Cases between August 2006 and February 2016 were reviewed using case notes and electronic hospital records. Data including mode of admission, clinical observations, investigations, operative interventions, microbiological and clinical outcomes was collected and reviewed. Analysis required multidisciplinary input including microbiology, infectious disease, trauma and orthopaedics, plastic surgery and intensive care teams. Results A total of 36 cases were identified. The mean laboratory risk indicator for necrotising fasciitis (LRINEC) score was 7 and 86% of patients fulfilled the criteria for necrotising fasciitis. Patients were commonly haemodynamically stable upon admission but deteriorated rapidly; 36% of patients had a temperature of over 37.5 degrees C on initial observations; 29/36 patients were discharged, 6 patients died acutely (acute mortality rate of 17%); 18/31 of cases were polymicrobial with Streptococcus pyogenes, the common organism. Six amputations or disarticulations were performed from a total of 82 operations in this group, with radical debridement the usual primary operation. The mean time to theatre was 3.54 hours. Highly elevated admission respiratory rate (50 breaths/minute) was associated with increased mortality. Conclusions Necrotising fasciitis presents subtly and carries significant morbidity and mortality. A high index of suspicion allows early diagnosis and intervention. We believe that a pan-specialty approach is the cornerstone for good outcomes.

Distinctions between Fournier's gangrene and lower extremity necrotising fasciitis: microbiology and factors affecting mortality

“…Gram-negative bacterium caused most NF cases in devel-oping countries, whereas Group A Streptococcus and S Aureus were still the predominant pathogens in the western world ( Foo et al, 2015 ;Kuehl et al, 2019 ;Thapaliya et al, 2015 ). Furthermore, there was a manifestation of higher mortality of FG than non-Fournier NF in developing countries, whereas just the opposite was true for developed countries ( Kuehl et al, 2019 ;Neilly et al, 2019 ;Sparenborg et al, 2019 ). Based on the results, medical staff are able to make prompt decisions and intervene with appropriate antibacterial administrations.…”

Multidisciplinary treatment of a patient with necrotizing fasciitis caused by Staphylococcus aureus: A case report

“…Type I is the most common type (70%-90%) and is a mixed infection caused by Gram-positive cocci (Streptococcus and Staphylococcus), Gram-negative bacteria ( Escherichia coli , Acinetobacter, Pseudomonas, and Klebsiella), and anaerobic bacteria such as Clostridium and Bacteroides[5,6]. Type II NF is generally monomicrobial, usually caused by group A Streptococcus alone or in combination with Staphylococcus aureus [7]. Type III describes a specific infection caused by marine Vibrio vulnificus [8].…”

“…Systemic clinical symptoms include fever, toxic delirium, typical signs of shock (tachycardia and hypotension), and eventually multi-organ dysfunction[13-15]. According to the current literature, the incidence of NF is relatively low, but the reported total mortality rate is as high as 20%[7]. The total cost of treatment during hospital stay was significantly high.…”

Utilidades del razonamiento bayesiano en la aproximación diagnóstica de las infecciones necrosante de piel y tejidos blandos

“…El Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) es una puntuación de predicción útil como prueba de diagnóstico para los pacientes con sospecha de fascitis necrosante no purulenta (13,14). A pesar de su variabilidad en la literatura, muchos estudios observacionales que incluyen un número significativo de pacientes han reportado una sensibilidad del 76,3 % y una especificidad del 93,1 %, LR + de 11,1 y un LR -de 0,25 (15,16). Los resultados recientes de una cohorte de 294 pacientes han descrito una función de valor pronóstico potencial para este indicador de riesgo (10,17).…”