Necrotizing soft-tissue infections in New Caledonia: Epidemiology, clinical presentation, microbiology, and prognostic factors

Necrotizing soft-tissue infections (NSTIs) are severe and rapidly progressive infectious conditions. We herein describe the clinical characteristics, microbiology, and prognosis factors of NSTIs in New Caledonia.

All patients admitted for confirmed NSTIs at the only surgical facility in New Caledonia from January 2008 to July 2013 were retrospectively included. Factors associated with mortality were analyzed by multivariate risk regression.

Over the period under review, 67 patients were studied (annual incidence rate, 6.1/year/100,000 inhabitants). The overall mortality rate was 24%. Melanesian people (n = 47; 70%) were more affected than other ethnic groups (n = 20; 30%; p = 0.001). The mean age was 54 years, and men were predominantly affected (n = 46; 69%). The most common comorbidity reported was diabetes mellitus (n = 24; 36%). Nonsteroidal anti-inflammatory intake prior to admission was reported in 14 cases (21%). Lower limbs were the most commonly affected anatomical sites (n = 36; 54%). At least one pathogen was identified in 31 cases (46%), whereas polymicrobial flora was found in 26 cases (39%). No bacteria were isolated in 10 cases (15%). Streptococcus pyogenes was the most frequently isolated bacterium (n = 21; 32%). Factors associated with mortality were use of norepinephrine [odds ratio (OR) 25.6; 95% confidence interval (CI) 4.8-135.8] and presence of two comorbidities (OR 8.6; 95% CI 1.7-42.3).

NSTIs are particularly frequent in New Caledonia. Local health care workers should have a high index of suspicion for the disease to initiate surgical and medical treatments early.