Early Diagnosis and Surgical Treatment for Necrotizing Fasciitis: A Multicenter Study
Evangelos P Misiakos1, George Bagias1, Iordanis Papadopoulos2
13rd Department of Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital , Athens , Greece.
Background:
Necrotizing fasciitis (NF) is a group of relatively rare infections, usually caused by two or more pathogens. It affects the skin and subcutaneous tissues of lower and upper limbs, perineal area (Fournier's gangrene), and the abdominal wall. Early diagnosis and aggressive surgical management are of high significance for the management of this potentially lethal disease.
Methods:
We conducted a retrospective study in patients who presented, during the last decade, at four University Surgical Departments in the area of Athens, Greece, with an admission diagnosis of NF. Demographic, clinical, and laboratory data were gathered, and the preoperative and surgical treatment, as well as the postoperative treatment was analyzed for these patients.
Results:
A total of 62 patients were included in the study. The mean age of patients was 63.7 (47 male patients). Advanced age (over 65 years) (P < 0.01) and female sex (P = 0.04) correlated significantly with mortality. Perineum was the mostly infected site (46.8%), followed by the lower limbs (35.5%), the upper limbs, and the axillary region (8.1%). Diabetes mellitus was the most common coexisting disease (40.3%), followed by hypertension (25.8%) and obesity (17.7%). The most common symptom was local pain and tenderness (90.3%). Septic shock occurred in eight patients (12.9%) and strongly correlated with mortality (P < 0.01). Laboratory data were used to calculate the LRINEC score of every patient retrospectively; 26 patients (41.9%) had LRINEC score under 6, 20 patients (32.3%) had LRINEC score 6-8, and 16 patients (25.8%) had LRINEC score >9. Surgical debridement was performed in all patients (mean number of repeated debridement 4.8), and in 16 cases (25.8%) the infected limb was amputated. The mean length of hospital stay was 19.7 days, and the overall mortality rate of our series was 17.7%.
Conclusion:
Diagnosis of NF requires high suspect among clinicians, as its clinical image is non-specific. Laboratory tests can depict the severity of the disease; therefore, they must be carefully evaluated. Urgent surgical debridement is the mainstay of treatment in all patients; the need of repetitive surgical debridement is undisputed.
Insights
Necrotizing fasciitis (NF) is a severe infection requiring prompt surgical intervention. This study found advanced age, female sex, and septic shock significantly correlate with mortality in NF patients.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Critical Care Medicine
Background:
- Necrotizing fasciitis (NF) is a rare, polymicrobial infection affecting deep soft tissues.
- It commonly impacts the perineum, lower limbs, and abdominal wall.
- Early diagnosis and aggressive surgical management are critical for survival.
Purpose of the Study:
- To analyze demographic, clinical, and laboratory data of patients diagnosed with NF.
- To identify factors associated with mortality in NF.
- To evaluate treatment strategies and outcomes for NF.
Main Methods:
- Retrospective study of 62 patients admitted with NF over a decade.
- Data collection included demographics, clinical presentation, comorbidities, and laboratory results.
- Analysis of surgical interventions, including debridement and amputation, and patient outcomes.
Main Results:
- The mean age of patients was 63.7 years; advanced age and female sex correlated with mortality.
- The perineum was the most frequent infection site (46.8%).
- Septic shock (12.9%) and a low LRINEC score (<6) were associated with increased mortality (17.7% overall).
- All patients underwent surgical debridement, with 25.8% requiring amputation.
Conclusions:
- NF diagnosis requires high clinical suspicion due to non-specific symptoms.
- Laboratory tests, including the LRINEC score, are crucial for assessing disease severity.
- Urgent and potentially repetitive surgical debridement is the cornerstone of NF treatment.
