Necrotizing Fasciitis

Astorino, Tina; Genrich, Ilean; Macgregor, Laura; Victor, Carol; Eckhouse, Diane R.; Barbour, Laurel

doi:10.1097/nor.0b013e318199ecb4

Cited by 5 publications

(1 citation statement)

References 6 publications

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“… 10 , 12 , 15 Treatment of NF includes early surgical debridement and broad-spectrum antibiotics. 2 , 16 – 18 Thus, awareness of the clinical characteristics of the individual patient could benefit early diagnosis and surgical intervention to reduce the morbidity of NF.…”

Section: Discussionmentioning

confidence: 99%

Necrotizing fasciitis: epidemiology and clinical predictors for amputation

Khamnuan

Chongruksut²,

Jearwattanakanok³

et al. 2015

IJGM

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BackgroundNecrotizing fasciitis, a relatively uncommon infection involving the skin, subcutaneous tissue, and fascia, is a rapidly progressive soft tissue infection and a medical and surgical urgency. Delayed debridement, with subsequent huge soft tissue loss is associated with loss of limb and infection and is the most common cause of mortality. The purpose of this work is to describe the epidemiology of necrotizing fasciitis and to identify the clinical characteristics that may be used to predict amputation in routine clinical practice.MethodsRetrospective cohort study data were collected from three general hospitals located in the Chiang Rai, Kamphaeng Phet, and Phayao provinces in northern Thailand. Epidemiologic data for all patients with a surgically confirmed diagnosis of necrotizing fasciitis between 2009 and 2012 were collected. Medical records and reviews were retrieved from inpatient records, laboratory reports, and registers. Clinical predictors for amputation were analyzed by multivariable risk regression.ResultsA total of 1,507 patients with a diagnosis of necrotizing fasciitis were classified as being with amputation (n=127, 8.4%) and without amputation (n=1,380, 91.6%). The most common causative Gram-positive and Gram-negative pathogens were Streptococcus pyogenes (33.3% in the amputation group and 40.8% in the non-amputation group) and Escherichia coli (25% in the amputation group and 17.1% in the non-amputation group). Predictive factors for amputation included gangrene (risk ratio [RR] 4.77, 95% confidence interval [CI] 2.70–8.44), diabetes mellitus (RR 3.08, 95% CI 1.98–4.78), skin necrosis (RR 2.83, 95% CI 2.52–3.18), soft tissue swelling (RR 1.76, 95% CI 1.24–2.49), and serum creatinine values ≥1.6 mg/dL on admission (RR 1.71, 95% CI 1.38–2.12). All data were analyzed using the multivariable risk regression generalized linear model.ConclusionThe most causative pathogens were S. pyogenes and E. coli. Clinical predictors for amputation in patients with necrotizing fasciitis included having diabetes mellitus, soft tissue swelling, skin necrosis, gangrene, and serum creatinine values ≥1.6 mg/dL on admission. Thus, patients with any of these predictors should be monitored closely for progression and receive early aggressive treatment to avoid limb loss.

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Section: Discussionmentioning

confidence: 99%

Necrotizing fasciitis: epidemiology and clinical predictors for amputation

Khamnuan

Chongruksut²,

Jearwattanakanok³

et al. 2015

IJGM

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Three Ds for diagnosing necrotizing fasciitis by front-line clinicians

Haykal

Hadzimustafic

Ghazarian

et al. 2023

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Necrotizing fasciitis

Lancerotto

Tocco

Salmaso

et al. 2012

Journal of Trauma and Acute Care Surgery

161

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Necrotizing fasciitis (NF), a life-threatening rare infection of the soft tissues, is a medical and surgical emergency. It is characterized by subtle, rapid onset of spreading inflammation and necrosis starting from the fascia, muscles, and subcutaneous fat, with subsequent necrosis of the overlying skin. Once suspected, immediate and extensive radical debridement of necrotic tissues is mandatory. Appropriate antibiotics and intensive general support avoid massive systemic diffusion of the infective process and are the key for successful treatment. However, early diagnosis is missed or delayed in 85% to 100% of cases in large published series: because of the lack of specific clinical features in the initial stage of the disease, it is often underestimated or confused with cellulitis or abscess. Mortality rates are still high and have shown no tendency to decrease in the last 100 years. Unfortunately, the prevalence of the disease is such that physicians rarely become sufficiently confident with NF to be able to proceed with rapid diagnosis and management. This review covers the literature published in MEDLINE in the period 1970 to December 31, 2010. Particular attention is given to the clinical and laboratory elements to be considered for diagnosis. A wide variety of diagnostic tools have been described to facilitate and hasten the diagnosis of NF, but the most important tool for early diagnosis still remains a high index of clinical suspicion.

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Necrotizing Fasciitis

Cited by 5 publications

References 6 publications

Necrotizing fasciitis: epidemiology and clinical predictors for amputation

Necrotizing fasciitis: epidemiology and clinical predictors for amputation

Three Ds for diagnosing necrotizing fasciitis by front-line clinicians

Necrotizing fasciitis

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