Necrotizing Fasciitis: Treatment Concepts & Clinical Outcomes – An Institutional Experience.

Abstract

Abstract BACKGROUND: A severe infection of the skin and soft tissues, necrotizing fasciitis (NF), spreads quickly along the deep fascia. This study aimed to characterize the clinicopathological features and analyze the bacteria implicated in antibiotic sensitivity, surgical management, and diagnostic accuracy of the Laboratory risk indicator for Necrotizing Fasciitis (LRINEC) score for Necrotizing Soft Tissue Infection (NSTI) METHODS: This single-center prospective observational study was conducted in the Department of General Surgery, Kasturba Medical College, Manipal, with 171 proven cases of NSTI between 2019 and 2021. Clinico-demographic data and laboratory investigation values were collected at two time points (at admission and 72 hours after admission). Imaging data, LRINEC score, culture results, and antibiotic sensitivity were recorded. Appropriate descriptive and analytical statistics were used for the statistical analysis. RESULTS: Of the 171 patients, 150 were male (87.7%). The mean age was 57.6 ± 13.1 years. The presenting features in all the cases were pain, swelling, and fever. Diabetes mellitus (DM) is the most common comorbidity. The lower extremities were the most commonly affected sites. Streptococcus pyogenes showed significant growth in 25.41% of the samples. Ceftriaxone sensitivity was seen in 41/141. A score of ≥ 8 was obtained n 118/171 (69%) patients, suggesting a higher severity and significant risk for NSTI. The Area Under the Curve of Receiver Operating characteristic Curve (ROC) for establishing diagnostic accuracy for LRINEC was 0.694. Mortality was significantly higher in the patients with higher LRINEC scores and elevated procalcitonin. The mortality rate was higher in patients who underwent surgery within 12 hours. CONCLUSION: Necrotizing fasciitis is a soft tissue infection with a high mortality rate. The clinical features and determinants of mortality in patients with NF are highlighted in this study. At the outset, a high index of suspicion was critical. Using prognostic evaluation techniques in daily clinical practice will assist medical professionals in providing adequate on-time care and significantly lowering mortality. Delay in surgical intervention after admission is one of the most important determinants of mortality and morbidity.