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Understanding limb necrotizing infections: A comprehensive approach.
A Garrido-Hidalgo1, J García-Coiradas1, M Echevarría-Marín1
1Department of Traumatology and Orthopaedic Surgery, Hospital Clínico San Carlos, Madrid, España.
Revista Espanola De Cirugia Ortopedica Y Traumatologia
|November 9, 2024
Summary
Necrotizing soft tissue infections (NSTI) are serious and increasing. Early surgery and antibiotics are key, but outcomes remain challenging, with a 22.73% mortality rate in this study.
Area of Science:
- Infectious Diseases
- Surgical Infections
- Critical Care Medicine
Background:
- Necrotizing soft tissue infections (NSTI) present with nonspecific symptoms, necessitating a high index of suspicion.
- These infections are increasing, carrying significant risks of morbidity and mortality.
- A multidisciplinary approach, including antibiotics, surgical debridement, and life support, is essential for management.
Purpose of the Study:
- To analyze the characteristics, demographics, complications, and treatment outcomes of NSTI patients.
- To evaluate the correlation between the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, time to surgery, and patient outcomes.
- To compare findings with existing literature regarding NSTI management and prognosis.
Main Methods:
- A retrospective observational study of surgically treated NSTI patients from January 2016 to December 2022.
- Collection of epidemiological and clinical data, including time from symptom onset to presentation.
- Prospective calculation of the LRINEC score for all included patients.
Main Results:
- Twenty-two patients (mean age 54.8 years) were included, with a median of 3.5 days from symptom onset to emergency room visit.
- Common symptoms included severe pain, fever, skin lesions, hypotension, and tachycardia.
- The in-hospital mortality rate was 22.73%, with Streptococcus pyogenes being the most common pathogen identified.
Conclusions:
- A multidisciplinary approach with radical debridement and antibiotic therapy is the cornerstone of NSTI treatment.
- No significant correlation was found between LRINEC score, time to surgery, and outcomes in this cohort, contrary to some studies.
- Despite timely intervention, NSTI continues to be associated with high morbidity and mortality rates.
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