Integrated clinical care pathway for managing necrotising soft tissue infections

Necrotising soft tissue infections (NSTI) are relatively common infections with high morbidity and mortality rate, as they often present late in their course. Quick and aggressive surgical treatment improves survival and decreases hospital stay.

All patients with NSTI managed at our centre from June 2007 to January 2009 were included in this prospective study. We evaluated various parameters like age, co-morbidities, biochemical parameters, time interval between admission and first operative intervention, against duration of hospital stay and out come of the case.

Fifty-four patients with NSTI were admitted and treated during the study period. Male to female ratio was 6:1. Mean time interval between admission and operative intervention was 6 hours. Mean period of hospitalisation was 53 days and we had limb salvage rate of 100% and one mortality (1.85%). Diabetes mellitus was the most common co-morbid condition and Staphylococcus aureus the most common isolate. Presence of leucocytosis, hyponatraemia, hypoalbuminaemia, anaemia and deranged renal functions were found to be poor prognostic factors.

Late and varied presentation is the rule rather than exception with NSTI. Early recognition of the condition, with emergency operative intervention and repeated debridement by a dedicated surgical team, is the key to patient survival and limb salvage.