A Retrospective Review of 418 Cases of Necrotizing Fasciitis in Sisaket Hospital
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2010-01-02
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Faculty of Medicine, Khon Kaen University
Abstract
Background: Necrotizing fasciitis is a life-threatening soft-tissue infection. Prompt diagnosis and immediate aggressive surgical debridement of all compromised tissues are critical to reducing morbidity and mortality in these rapidly progressive infectionsObjective: The purposes of descriptive research were to analyse the Necrotizing fasciitis in Sisaket Hospital during the year 2004 to 2006, including 418 patients, in terms of incidence, clinical feature, microbiology, location of infection, risk factors, sign symptoms, co-morbidity, the type of therapy used (debridement or amputation), treatment, drug sensitivity and outcome.Setting: Sisaket HospitalResearch Design: Retrospective descriptive researchMethods: The study retrospectively investigated the medical records of 418 patients who were diagnosed and treated for necrotizing fasciitis during the year 2004 to 2006 at our hospital.Results: The incidence in the year 2004 to 2006 of male to female ratio 1.2:1. Age 2-95 years. The most of their occupation were farmer (83.0%). The highest number of patients came to the hospital in March to June. Pseudomonas aeruginosa was the common causative organism (26.3 %). Risk factors were the chronic wounds (24.9%), injury from sharp materials (16.2%) and minor lacerated wound (8.8%). The common location necrotizing fascitis was the subcutis of the leg (48.8%) and foot (28.5%). The comorbidity included hypovolumic shock (34.4%), septicemia (27.3%), diabetes mellitus (19.1%), and acute renal failure (14.8%). Pain and swelling occurred in most patients (44.0 %), and the presence of erythema and edema was variable; co-morbidity. Treatment included (86.6 %); debridement (92.5 %) and amputation to control infection. Eighty six point six percent of the patients were operated. An enhanced bactericidal response to amikacin was noted. There were 49 deaths (11.7%).Conclusions: Early recognition and treatment of necrotizing fasciitis and operative debridement was demonstrated to reduce mortality among patients with this condition. A high index of suspicion is important in view of the paucity of specific cutaneous findings early in the course of the disease.
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Srinagarind Medical Journal (SMJ); Vol. 23 No. 1 January-March 2008; 7-16