Insights into necrotising fasciitis: A prospective pilot study in a Tertiary Care Hospital
1Department of General Surgery, Saveetha Institute of Medical and Technical Sciences, India.
Introduction:
Necrotising fasciitis, commonly referred to as "flesh-eating disease," is a rapidly spreading soft tissue infection characterised by extensive necrosis of the skin, subcutaneous tissue, and fascia while sparing the underlying muscle. Despite its low overall incidence, it is a significant soft tissue infection due to its rapid spread and associated high mortality risk.
Materials And Methods:
This prospective pilot study aims to analyse 25 consecutive cases of necrotising fasciitis to assess various aspects, including age and sex incidence, microbial flora, role of co-morbidities in prognosis, and overall outcome. We conducted a descriptive study involving 25 patients aged 18-84 years diagnosed with necrotising fasciitis over a 6-month period (January 2022 to June 2022) at Saveetha Medical College.
Results:
Of the 25 patients treated, 21 (84%) were male and 4 (21%) were female, resulting in a male-to-female ratio of 5.25. The age ranged from 18 to 84 years (Mean age: 50.24 ± Standard deviation, SD=14.175). Trauma was identified as the main precipitating factor in approximately 40% of cases, while Diabetes Mellitus (40%) emerged as the most common co-morbidity. Lower limb involvement was predominant in both male and female patients. The infection was monomicrobial in 32% of cases (Enterococci 16% + Bacteroides 16%) and poly-microbial in 68% with Streptococcus pyogenes + Escherichia coli being the most common organism combination. Wound debridement followed by split skin graft was the most common treatment modality (84%), with the number of debridement sessions varying based on infection severity (corresponding with higher LRINEC scores). Prolonged hospital stay was the most common complication, observed in 52% of cases.
Discussion:
Our analysis revealed that necrotising fasciitis is more prevalent in individuals aged over 50 years with a male predominance. Streptococcus pyogenes with Escherichia coli was the predominant microflora, and Diabetes Mellitus emerged as the most common comorbidity. Early recognition, prompt control of diabetes mellitus, aggressive surgical treatment, and supportive therapy are essential steps in managing necrotising fasciitis.
Insights
Necrotising fasciitis, a severe flesh-eating disease, predominantly affects males over 50. Diabetes Mellitus is a key comorbidity, with Streptococcus pyogenes and Escherichia coli being common causes.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Epidemiology
Background:
- Necrotising fasciitis, or flesh-eating disease, is a rapidly progressing soft tissue infection with high mortality.
- It involves extensive necrosis of skin, subcutaneous tissue, and fascia, sparing underlying muscle.
Purpose of the Study:
- To analyze 25 cases of necrotising fasciitis.
- To assess incidence by age and sex, microbial flora, comorbidities' impact on prognosis, and outcomes.
Main Methods:
- A prospective, descriptive pilot study of 25 patients diagnosed with necrotising fasciitis.
- Data collected over a 6-month period (January 2022 - June 2022).
Main Results:
- Predominantly affected males (84%) aged 18-84 years (mean 50.24).
- Trauma (40%) and Diabetes Mellitus (40%) were primary factors; lower limb involvement was common.
- Polymicrobial infections (68%) were frequent, with Streptococcus pyogenes + Escherichia coli noted. Wound debridement and skin grafting were primary treatments; prolonged hospital stay was a common complication (52%).
Conclusions:
- Necrotising fasciitis is more common in males over 50, often linked to Diabetes Mellitus.
- Streptococcus pyogenes and Escherichia coli are key pathogens.
- Early diagnosis, diabetes management, aggressive surgery, and supportive care are crucial for effective management.
