Necrotizing soft tissue infection: clinical characteristics and outcomes at a reconstructive center in Jilin Province

Abstract

BackgroundTo investigate the clinical characteristics and treatment outcomes in necrotizing fasciitis (NF) patients in a reconstructive unit in northeastern China.MethodsMedical records of patients diagnosed with and treated for NF in the extremities from November 2013 to December 2016 were retrospectively reviewed. Demographic data, clinical presentation, duration of signs and symptoms, location of infection, predisposing factors, causative microbiological organisms, laboratory risk indicator for necrotizing fasciitis (LRINEC) score, number of surgical debridements, length of hospital stay, treatments, and outcomes were recorded.ResultsA total of 39 consecutive patients were treated for severe NF (32 male and 7 female). Diabetes mellitus and blunt trauma were the most common risk factors (13 and 9 cases, respectively). The positive predictive value of the LRINEC score in NF diagnosis was 46.2%. Mean duration of signs and symptoms was 4.6 days. Staphylococcus aureus was the most commonly isolated bacteria (20 cases). All patients underwent their first debridement within 12 h of presentation (mean, 4.6 h). Mean number of surgical treatments was 2.8 (range, 2–5) per patient, including debridements. All patients survived, and mean length of hospital stay was 30.81 (range, 21–43) days. Three patients underwent limb amputation.ConclusionsIn our clinical experience, early detection and aggressive debridement are the cornerstones of NF treatment. Antibiotic therapy and intensive care support is essential in severe cases of NF. Anaerobic tissue culture and frozen section biopsy could be adopted as routine tests for diagnosis and decision-making in NF. These findings should inform clinical decisions about the treatment of individual patients with NF.

Necrotizing skin and soft-tissue infections in the intensive care unit

“…In one report, only half of them were able to return directly home while the others needed further hospitalization or transfer to an inpatient rehabilitation facility [26]. Importantly, about 10%e 20% of patients with limb NSTI will eventually require amputation [23,27,30,33,34,36,38,42,45].…”

Necrotizing soft tissue infection of both ear lobules occurring concomitantly in a set of twins following non-aseptic ear piercing: a case report

“…Necrotizing soft tissue infection of the ear is extremely rare with a tendency to misdiagnosis resulting in extensive tissue loss and concurrent reconstructive challenges [1,10].In neonates it is even more likely to miss the diagnosis except with high clinical index of suspicion. It is predominantly an adult condition with Fig.…”

“…Necrotizing soft tissue infection (NSTI) is a potentially life-threatening emergency that results from various combinations of organisms [1]. They are generally a rare condition that may affect any part of the body.…”

Diagnosing Necrotizing Fasciitis Using Procalcitonin and a Laboratory Risk Indicator: Brief Overview

“…Necrotizing fasciitis (NF) is a severe and life-threatening soft tissue infection characterized by progressive necrosis of the fascia and subcutaneous tissue occurring along the fascial planes [ 1 ]. It is more prevalent among those having diabetes mellitus, the immunodeficient status, malnutrition, and illicit drug usage.…”

“…The mortality can reach up to 100% if not diagnosed and treated [ 2 ]. A patient’s clinical characteristics, surgical exploration, microbiological and histopathological analysis of soft tissue are the gold standard for the diagnosis of NF [ 1 ]. These tests can be invasive and time-consuming and delay the treatment, increasing the chances of mortality.…”