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Necrotising fasciitis: a single centre's experience
J A Rietveld1, H L Pilmore, P G Jones
1Department of Orthopaedic Surgery, University of Otago Medical School, Dunedin.
Aims:
Necrotising fasciitis is a rare but serious soft tissue infection with high morbidity and mortality. We wished to review our 5 year experience with this condition 1989-94. In addition, in light of recent interest in the association between necrotising fasciitis and nonsteroidal antiinflammatory drugs, we wished to determine the incidence of NSAID use in our necrotising fasciitis patients.
Methods:
A review of all Dunedin Hospital cases of necrotising fasciitis between January 1989-June 1994 was undertaken. Subsequently all specialists involved in treating the patients audited the notes, particularly regarding clinical presentation, complications, treatment, outcome and concomitant use of NSAIDs was also recorded.
Results:
There have been seven patients (4 males) with a mortality rate of 43%. Survival was associated with early diagnosis, rapid and intensive medical and surgical intervention, and possibly the early use of haemofiltration. Five of the seven patients had ingested nonsteroidal antiinflammatory drugs (NSAID) prior to their presentation which may have potentiated the severity of the endotoxic shock.
Conclusion:
Necrotising fasciitis remains a potentially lethal disease but early management and aggressive treatment improves outcome. A high index of suspicion, avoidance of NSAIDs, and aggressive multidisciplinary team management of these patients offers the best chance of survival in necrotising fasciitis.
Insights
Necrotising fasciitis is a severe infection with a high mortality rate. Early diagnosis and treatment, alongside avoiding nonsteroidal anti-inflammatory drugs (NSAIDs), improve patient survival chances.
Area of Science:
- Infectious Diseases
- Surgical Pathology
- Toxicology
Background:
- Necrotising fasciitis is a rare but life-threatening soft tissue infection characterized by high morbidity and mortality.
- This study reviews a 5-year experience with necrotising fasciitis (1989-1994) at Dunedin Hospital.
- Investigates the association between necrotising fasciitis and nonsteroidal anti-inflammatory drug (NSAID) use.
Observation:
- Seven cases of necrotising fasciitis were identified, with a mortality rate of 43%.
- Survival was linked to early diagnosis, prompt medical and surgical intervention, and potentially early haemofiltration.
- Five of the seven patients reported NSAID ingestion prior to presentation, suggesting a possible role in potentiating endotoxic shock severity.
Findings:
- Early diagnosis and aggressive, multidisciplinary management significantly improve outcomes in necrotising fasciitis.
- A high index of suspicion is crucial for timely intervention.
- Avoidance of NSAIDs may be beneficial in managing patients with necrotising fasciitis.
Implications:
- Findings underscore the critical need for prompt diagnosis and aggressive treatment strategies for necrotising fasciitis.
- Highlights the potential detrimental role of NSAIDs in necrotising fasciitis, warranting caution in their use.
- Emphasizes the importance of a multidisciplinary approach in improving survival rates for this severe infection.