Twelve-Year Experience with Necrotising Fasciitis in an Intensive Care Unit of a Local Regional Hospital

Abstract

Background Necrotising fasciitis (NF) is a life threatening condition and is a medical and surgical emergency. The mainstay of management includes early recognition, prompt surgical intervention, appropriate antibiotics and intensive care for organ support. However, the mortality is still very high despite the advance in the intensive care. Objective To examine the 12-year outcomes, causative organisms, time to diagnosis, surgery and institution of adequate antibiotic coverage of patients with NF admitted to the intensive care unit (ICU) in a local regional hospital; and to identify the independent predictors of ICU mortality. Method We performed a retrospective analysis of the clinical records of all patients with NF admitted to the ICU between 1st July 2002 and 30th June 2014. Logistic regression analysis was conducted to identify the independent predictors of ICU mortality. Results One hundred and thirty seven patients were recruited. Causative organisms included: Group A Streptococcus (16.2%), other streptococcus (31.1%), Methicilin-resistant Staphylococcus aureus (8.8%), Vibrio species (14%) and other Gram negatives (44%). The mean length of ICU stay was 9.9 days (range: 1-74 days) and the ICU mortality rate was 42.3%. The APACHE II score (odds ratio [OR] 1.132; 95% confidence interval [CI] 1.060-1.209), Diabetes Mellitus (OR 5.017; 95% CI 1.919-13.119), Glasgow coma scale ≤8 (OR 4.525; 95% CI 1.319-15.530), low white cell count (OR 0.931; 95% CI 0.876-0.990) and urea level (OR 1.049; 95% CI 1.001-1.100) were statistically significant independent predictors of ICU mortality. Conclusions The mortality of patients with NF in ICU remains very high. The causative microorganisms in our locality are similar to those observed elsewhere. NF patients treated in ICU with underlying diabetes mellitus or presenting with Glasgow Coma Scale less than 8 are significantly more likely to die.