Presentation and outcomes of necrotizing soft tissue infections

Chen, Kuan-chin Jean; Klingel, Michelle; McLeod, Shelley; Mindra, Sean; Ng, Victor

doi:10.2147/ijgm.s131768

Cited by 26 publications

(25 citation statements)

References 31 publications

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“…In our study, LRINEC score > 8 showed a statistically significant difference between mortality of the primary and late amputation groups. Chen et al identified vascular disease as a common comorbidity of necrotizing soft tissue infections [14]. On the basis of this study, we found that peripheral artery disease was an important independent factor associated with mortality in late amputation.…”

Section: Discussionsupporting

confidence: 56%

Risk factors for mortality in the late amputation of necrotizing fasciitis: a retrospective study

et al. 2018

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BackgroundNecrotizing fasciitis (NF) is a rapidly progressive infectious disease that primarily involves the fascia and subcutaneous tissue. If not promptly treated, it can lead to morbidity as well as mortality. It can affect any part of the body, most commonly the extremities. Early and aggressive surgical treatment is the proper way of management. The purpose of this study was to identify the risk factors for mortality in late amputation among NF patients that may be used in routine clinical practice to prevent mortality.MethodsA retrospective cohort study of hospitalized patients with NF was conducted in a tertiary teaching hospital in Taiwan between March 2015 and March 2018. All collected data were statistically analyzed.ResultsA total of 582 patients with NF were included; 35 of them had undergone amputation (7 primary and 28 late amputations), with a 6% amputation rate. Thirteen amputated patients still died eventually (all in the late amputation group). Significant risk factors for mortality identified in the late amputation group included hemorrhagic bullae (p = 0.001, OR 4.7, 95% confidence interval (CI) 2.68–8.69), peripheral vascular disease (p < 0.001, OR 3.2, 95% CI 1.12–10.58), bacteremia (p = 0.021, OR 2.87, 95% CI 2.07–5.96), and Laboratory Risk Indicator of Necrotizing Fasciitis (LRINEC) score > 8 (p < 0.001, OR 1.97, 95% CI 1.28–4.61). Vibrio vulnificus was the main causative organism based on our study, but the microbiology results showed no significant correlation.ConclusionNF patients with hemorrhagic bullae, comorbidity with peripheral vascular disease, presence of bacteremia, or LRINEC score > 8 should receive early and primary amputation in order to prevent mortality.

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Section: Discussionsupporting

confidence: 56%

Risk factors for mortality in the late amputation of necrotizing fasciitis: a retrospective study

et al. 2018

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“…23 NSTI appears to more commonly affect individuals with significant chronic health issues. 24 Most common comorbidities include diabetes mellitus, 4,[25][26][27][28] immunocompromise, [29][30][31] peripheral arterial disease, 30,32 obesity, 28,33 chronic liver disease, 7,34,35 malignancy, 32,36,37 and organ transplantation. [38][39][40] Otherwise healthy individuals developing NSTIs triggered by elective medical procedures, 41 medication injections or vaccinations, 42,43 or minimal trauma 20 have also been reported.…”

Section: Epidemiologymentioning

confidence: 99%

Necrotizing Soft Tissue Infections in the Vasculopathic Patient: Review of Literature

Tsang

Cao²,

Gunanayagam³

et al. 2019

International Surgery

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Background: Necrotizing soft tissue infection is a surgical emergency associated with high mortality. Its presence in patients with risk factors for peripheral arterial disease such as diabetes mellitus is consistently associated with significantly poorer outcomes. Though it has been over a century since it was initially described in the literature, mortality rates remain high and treatment regimens are not standardized. Materials and methods: PubMed and Cochrane databases were searched for articles pertaining to necrotizing soft tissue infections. Articles were screened for relevance with the intent to compare outcomes in prospective studies of patients with diabetes mellitus or peripheral arterial disease. Patient demographics, clinical findings, mortality, rates of amputation, and morbidity were intended to be compared. Results: 857 articles were identified, 165 duplicates were removed, and 6 prospective trials were identified for inclusion. Due to significant paucity of data, patient heterogeneity, and lack of standardization for surgical management, a descriptive review of the literature in relation to necrotizing soft tissue infections was pursued, with a focus on high-risk patients with peripheral arterial disease or diabetes mellitus. Conclusions: Early aggressive surgical intervention or major amputation may reduce mortality at the cost of increased disability and poorer quality of life in the long term, and may be appropriate in vasculopaths with poorly controlled diabetes and rapidly progressive fulminant infection. However, there is a deficiency in high-level evidence supporting surgical decision-making in this setting, with no standardized protocols for amputation. Future research will be needed to clarify the patient population who would benefit from radical amputation versus intention for limb salvage.

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“…Conditions associated with NF include diabetes mellitus, renal insufficiency, arterial occlusive disease, intravenous drug abuse, body mass index > 30 kg/m², age > 65 years, liver disease, immunosuppression, recent surgery, and traumatic wounds or incision of the skin including minor lesions such as insect bites and injections sites [2][3][4]. NF has been classified into four types depending on microbiological findings: type I is of polymicrobial aetiology, including aerobic and anaerobic organisms; type II is caused by group A streptococci (GAS), either alone or in association with staphylococci; type III is represented by monomicrobial infections attributable to Clostridium species or Gram-negative bacteria; type IV is of fungal aetiology [1,5].…”

Section: Necrotising Fasciitis: An Overviewmentioning

confidence: 99%