A Retrospective Review of 418 Cases of Necrotizing Fasciitis in Sisaket Hospital

Abstract

Background: Necrotizing fasciitis is a life-threatening soft-tissue infection.  Prompt diagnosis and immediate aggressive surgical debridement of all compromised tissues are critical to reducing morbidity and mortality in these rapidly progressive infections

Objective  : The  purposes  of  descriptive   research  were  to  analyse the  Necrotizing  fasciitis  in  Sisaket Hospital during  the  year  2004 to 2006, including  418 patients  ,  in  terms  of  incidence,  clinical  feature,  microbiology,   location of infection, risk  factors, sign symptoms, co-morbidity ,the type of therapy used (debridement or amputation), treatment,  drug sensitivity and outcome.

Setting  : Sisaket Hospital

Research  Design    : Retrospective  descriptive research

Materials and Methods : The study  retrospectively  investigated the  medical  records  of  418  patients  who  were  diagnosed  and  treated  for necrotizing fasciitis during  the  year  2004 to 2006 at our  hospital.

Results : The  incidence   in  the  year  2004  to  2006  of   male to female ratio 1.2 : 1.  Age  2-95 years.The most of their occupation  were farmer(83.0%), The highest number of patients came to the hospital in March to June. Pseudomonas  aeruginosa  was the common causative organism(26.3 %).  Risk factors was  the chronic wounds (24.9%), injury from sharp materials (16.2%) and minor lacerated wound (8.8%).  The common location necrotizing fascitis was the subcutis of the leg (48.8%) and foot (28.5%).  The comorbidity included hypovolumic shock (34.4%), septicemia (27.3%), diabetes mellitus (19.1%), acute renal failure (14.8%).  Pain and swelling occurred in most  patients (44.0 %), and the presence of erythema and edema was variable ; co-morbidity. Treatment included  (86.6 %) ; debridement (92.5 %) and amputation to control infection.  Eighty-six point six percent of the patient were operated.  An enhanced bactericidal response to  amikacin was noted. There were 49 deaths  (11.7%).

Conclusions: Early recognition and treatment of necrotizing fasciitis   and operative débridement was demonstrated to reduce mortality among patients with this condition. A high index of suspicion is important in view of the paucity of specific cutaneous findings early in the course of the disease.