Epidemiology and prognostic factors of necrotizing fasciitis in resource-limited regions based on 119 cases

Necrotizing fasciitis (NF) is a rare, life-threatening soft tissue infection with high amputation and mortality rates, often due to delayed diagnosis and treatment. This study analyzes the clinical characteristics and prognostic factors of NF to improve treatment strategies. A retrospective study was conducted on 119 NF patients treated at a tertiary hospital in Guangxi, China, from 2017 to 2023. Data on demographics, laboratory parameters, microbiology, treatments, and outcomes were collected and analyzed. Comparisons were made between survivors and non-survivors, and between patients with and without amputation. The predictive performance of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) was assessed using receiver operating characteristic (ROC) curve analysis. Among 119 patients, the mean age was 56.7 years with a male-to-female ratio of 5.3:1. The lower extremities were most commonly affected (58.8%), and diabetes was prevalent (62.3%). Gram-negative bacteria were predominant (62.7%), particularly Escherichia coli (21.6%) and Klebsiella pneumoniae (19.4%), while Gram-positive bacteria were led by Staphylococcus aureus (14.9%). The overall antibiotic resistance rate was 18.7%, with Gram-negatives bacteria highly susceptible to ertapenem, imipenem, and piperacillin-tazobactam, and Gram-positives bacteria to vancomycin and levofloxacin. Amputation and in-hospital mortality rates were 16.8% and 11.8%, respectively. Risk factors for amputation encompassed lower extremity involvement, cutaneous and muscle necrosis, diabetes, elevated LRINEC scores, low RBC counts, and decreased albumin (all p < 0.05). Mortality was associated with advanced age, hypotension, coronary heart disease, hypoalbuminemia, elevated serum creatinine, uric acid, and lactate (all p < 0.05). The LRINEC score showed moderate predictive power for amputation (AUC = 0.726, cutoff = 8) but limited utility for mortality prediction (AUC = 0.592). NF predominantly affects middle-aged and elderly males, with diabetes as a common underlying condition. Early surgical intervention and empirical use of carbapenems combined with vancomycin are recommended for infection control. Enhancing early treatment effectiveness and optimizing disease management are key to improving patient outcomes in resource-limited settings.