A retrospective review of necrotizing fasciitis in Thammasat University Hospital.

OBJECTIVE

Necrotizing fasciitis is a rapidly progressive soft tissue infection. Clinicalfeatures and microbial knowledge will help reduce mortality and morbidity from delayed diagnosis and treatment.

MATERIAL AND METHOD: From January 2004 to December 2009, records of 222 necrotizing fasciitis patients were reviewed for the study. The following data were collected and recorded: age, sex, location of lesion, inciting event, clinical manifestation, culture and sensitivity and procedures.

RESULTS

The male-to-female ratio was 1.4:1 with 56.3 years mean age. The most of the occupations were elderly who stay at home and laborers. The highest incidence rate was during the raining seasons. The most common infection site was at the lower extremity with unknown inciting event. A common underlying disease was diabetes. The major complains presented was skin lesion, fever with chill, conscious change, gastrointestinal symptom. Examination revealed erythematous and swelling skin lesion (100%), fever (50.9)%, hypotension blood pressure (32.4%). Positive wound culture isolation was 55.9% and in blood culture was 48%. Dominant gram negative bacteria (71.98%) were in wound culture but gram positive bacteria (51.28%) were dominant in blood culture. Polymicrobial isolates in wound culture was 48% and in blood culture was 6%. The average 2.5 procedures were debridement (33.8%), skin graft coverage (59.9%), amputation (15.4%). Mortality rate was 5.9% that 46.2% were diabetes.

CONCLUSION

Gram negative organisms were predominant wound isolates whereas gram positive organisms were predominant blood isolates. With high polymicrobial isolation, clinical manifestation can be described as necrotizing fasciitis type I. The elderly and diabetic patients were at risk. Early diagnosis is important in patients with fever, toxicity and erythematous swelling skin findings. The hallmarks of treatment are prompt surgical opening and debridement to get rid of the source of infection and broad-spectrum antibiotics treatment administered.