• Cirrhosis
• Hospital charges
• Mortality
• Necrotizing fasciitis
• Septic shock

• BMI
• Necrotizing fasciitis
• Necrotizing soft tissue infection
• Obesity
• Overweight
• Sepsis

• Humans
• Fasciitis, Necrotizing/therapy
• Fasciitis, Necrotizing/mortality
• Male
• Female
• Retrospective Studies
• Middle Aged
• Overweight/complications
• Debridement
• Adult
• Anti-Bacterial Agents/therapeutic use
• Aged
• Body Mass Index
• Risk Factors
• Severity of Illness Index

• LRINEC
• NSTI
• Necrotizing fasciitis
• Procalcitonin

• Humans
• Fasciitis, Necrotizing/diagnosis
• Fasciitis, Necrotizing/therapy
• Fasciitis, Necrotizing/microbiology
• Fasciitis, Necrotizing/surgery
• Male
• Female
• Middle Aged
• Prospective Studies
• Anti-Bacterial Agents/therapeutic use
• Aged
• Adult
• Debridement/methods
• Treatment Outcome
• Streptococcus pyogenes/isolation & purification

• Manipal Academy of Higher Education, Manipal

• Humans
• Soft Tissue Infections/diagnostic imaging
• Point-of-Care Systems
• Ultrasonography
• Skin Diseases, Infectious/diagnostic imaging

• Soft tissue infection
• gangrene
• necrotizing fasciitis
• significant surgical infection

• Humans
• Male
• Adult
• Ethiopia/epidemiology
• Female
• Tertiary Care Centers
• Middle Aged
• Soft Tissue Infections/surgery
• Soft Tissue Infections/mortality
• Soft Tissue Infections/therapy
• Cross-Sectional Studies
• Debridement
• Treatment Outcome
• Length of Stay
• Risk Factors
• Fasciitis, Necrotizing/surgery
• Fasciitis, Necrotizing/mortality
• Fasciitis, Necrotizing/therapy
• Necrosis

• Fournier gangrene
• Medicaid
• Medicare
• amputation
• gas gangrene
• necrotizing fasciitis

• Humans
• Male
• Female
• Middle Aged
• Soft Tissue Infections/epidemiology
• Soft Tissue Infections/therapy
• Soft Tissue Infections/mortality
• Soft Tissue Infections/economics
• Hospitalization/statistics & numerical data
• Hospitalization/economics
• Aged
• Adult
• Insurance Coverage/statistics & numerical data
• Fasciitis, Necrotizing/mortality
• Fasciitis, Necrotizing/epidemiology
• Fasciitis, Necrotizing/therapy
• United States/epidemiology
• Young Adult
• Aged, 80 and over
• Length of Stay/statistics & numerical data
• Gas Gangrene/therapy
• Gas Gangrene/epidemiology
• Adolescent
• Medically Uninsured/statistics & numerical data
• Fournier Gangrene/therapy
• Fournier Gangrene/mortality
• Fournier Gangrene/epidemiology
• Insurance, Health/statistics & numerical data

• Humans
• Soft Tissue Infections/diagnosis
• Soft Tissue Infections/therapy
• Sepsis/diagnosis
• Thorax/diagnostic imaging

• Craniotomy
• Skin necrosis
• Subgaleal drainage
• Subgaleal hematoma

• ASA classification
• comorbidity
• mortality
• necrotizing soft tissue infections

The primary aim of this study was to identify if there is an association between the operative time of the initial debridement for necrotizing soft tissue infections (NSTIs) and the mortality corrected for disease severity.

A retrospective multicenter study was conducted of all patients with NSTIs undergoing surgical debridement. The primary outcome was the 30-day mortality. The secondary outcomes were days until death, length of intensive care unit (ICU) stay, length of hospital stay, number of surgeries within first 30 days, amputations and days until definitive wound closure.

A total of 160 patients underwent surgery for NSTIs and were eligible for inclusion. Twenty-two patients (14%) died within 30 days and 21 patients (13%) underwent an amputation. The median operative time of the initial debridement was 59 min (IQR 35–90). In a multivariable analyses, corrected for sepsis just prior to the initial surgery, estimated total body surface (TBSA) area affected and the American Society for Anesthesiologists (ASA) classification, a prolonged operative time (per 20 min) was associated with a prolonged ICU (β 1.43, 95% CI 0.46–2.40; p = 0.004) and hospital stay (β 3.25, 95% CI 0.23–6.27; p = 0.035), but not with 30-day mortality. Operative times were significantly prolonged in case of NSTIs of the trunk (p = 0.044), in case of greater estimated TBSA affected (p = 0.006) or if frozen sections and/or Gram stains were assessed intra-operatively (p < 0.001).

Prolonged initial surgery did not result in a higher mortality rate, possible because of a short duration of surgery in most studied patients. However, a prolonged operative time was associated with a prolonged ICU and hospital stay, regardless of the estimated TBSA affected, presence of sepsis prior to surgery and the ASA classification. As such, keeping operative times as limited as possible might be beneficial for NSTI patients.

The online version contains supplementary material available at 10.1186/s12893-021-01456-0.

• Damage control
• Mortality
• Necrotizing fasciitis
• Necrotizing soft tissue infections
• Operative time
• Severe necrotizing soft tissue infection

• mnf scoring system
• necrotizing fasciitis
• novel clinical risk scoring model
• predicting mortality

• Area Under Curve
• Fasciitis, Necrotizing/mortality
• Fasciitis, Necrotizing/pathology
• Female
• Humans
• Middle Aged
• Predictive Value of Tests
• ROC Curve
• Retrospective Studies
• Risk Assessment/methods
• Risk Factors

Introduction

Necrotizing soft tissue infection (NSTI) of the upper extremity (UE) is a rapidly progressing infection that requires early diagnosis and emergent treatment to decrease risks of loss of limb or life. Clinical presentation, particularly of early NSTI, can appear similar to serious cellulitis or abscess. The purpose of this study was to identify factors that are associated with NSTI rather than serious cellulitis and abscess to differentiate patients with similar clinical presentations.

Methods

This study uses a retrospective cohort design that compares patients ultimately diagnosed with UE NSTI versus those diagnosed with UE serious cellulitis or abscess. Cohorts were matched using the Laboratory Risk Indicators for Necrotizing Fasciitis (LRINEC) score in the setting of UE soft tissue infection. Laboratory values, vital signs, subjective symptoms, and social factors including substance abuse and domiciled status were recorded. Continuous variables were compared using the Mann-Whitney U test, whereas categorical variables were compared using the chi-squared test or the Fisher exact test (for expected values less than 5). A binary logistic regression for continuous and categorical variables was also performed. Significance was set at p<0.05. Univariate and multivariate analyses were performed.

Results

Multivariate statistical analysis and clinical interpretation of data identified four factors more associated with a diagnosis of NSTI than serious cellulitis or abscess: elevated lactate on hospital presentation, a patient-reported history of fever, male gender, and homelessness. 

Conclusions

In patients with upper extremity infections, the clinical presentation of NSTI and serious cellulitis or abscess may appear similar. In this retrospective cohort of patients matched with LRINEC scores, elevated lactate, subjective fever, male gender, and homelessness were significantly associated with NSTI rather than serious cellulitis or abscess. 

• abscess
• cellulitis
• infection
• necrotizing
• soft tissue

Necrotizing soft tissue infection (NSTI) of the lower extremity (LE) is a rapidly progressing infection that requires early diagnosis and prompt treatment to decrease risks of loss of limb or life. Clinical presentation, particularly of early NSTI, can appear similar to severe cellulitis. The purpose of this study is to identify factors that are associated with NSTI rather than severe cellulitis to differentiate patients with similar clinical presentation.

This retrospective cohort design study compares patients finally diagnosed with LE NSTI versus those diagnosed with severe cellulitis. Cohorts were matched using the modified Laboratory Risk Indicator for Necrotizing Fasciitis (m-LRINEC) score in the setting of LE soft tissue infection. Laboratory values, vital signs, subjective symptoms, and social factors including substance abuse were recorded. Univariate and multivariate analyses were performed.

Multivariate statistical analysis and clinical interpretation of data identified four factors more associated with a diagnosis of NSTI than severe cellulitis: elevated lactate, a patient-reported history of fever, male gender, and intravenous substance user.

In patients with lower extremity infections, the clinical presentation of NSTI and severe cellulitis may appear similar. In this retrospective cohort of patients matched with m-LRINEC scores, elevated lactate, subjective fever, male gender, and intravenous substance abuser were significantly associated with NSTI rather than severe cellulitis. Further studies of these factors in the clinical setting can help tailor the differential diagnosis in the care of patients with severe lower extremity infections. Matched with m-LRINEC scores, elevated lactate, subjective fever, male gender, and intravenous substance abuser were significantly associated with NSTI rather than severe cellulitis. Further studies of these factors in the clinical setting can help tailor the differential diagnosis in the care of patients with severe lower extremity infections.

• cellulitis
• necrotizing soft tissue infection

• Debridement
• Disarticulation
• Hemipelvectomy
• Necrotising Fasciitis

• Qatar
• necrotizing fasciitis
• season
• temporal trend

• International normalised ratio
• Necrotising fasciitis
• Risk factors
• Sepsis

• Necrotising fasciitis
• burns centre management
• clinical outcomes

Necrotizing fasciitis is a severe bacterial skin infection that spreads quickly and is characterized by extensive necrosis of the deep and superficial fascia resulting in the devascularization and necrosis of associated tissues. Because of high morbidity and mortality, accurate diagnosis and early treatment with adequate antibiotics and surgical intervention are vital. And timely identification and treatment of complications are necessary to improve survival of patient.

We report a case of necrotizing fasciitis caused by Staphylococcus aureus in a patient using high doses of glucocorticoid and suffering from secondary diabetes mellitus. He was admitted to our hospital due to redness and oedema of the lower limbs. After admission, necrotizing fasciitis caused by Staphylococcus aureus was considered, and he was discharged after B-ultrasound drainage and multiple surgical operations. In the process of treatment, multiple organ functions were damaged, but with the help of multi-disciplinary treatment, the patient got better finally.

The key to successful management of necrotizing fasciitis is an early and accurate diagnosis. The method of using vacuum sealing drainage in postoperative patients can keep the wound dry and clean, reduce infection rate, and promote wound healing. Interdisciplinary collaboration is a vital prerequisite for successful treatment.

• Necrotizing fasciitis
• Surgical debridement
• Vacuum sealing drainage
• Multi-disciplinary treatment
• Case report

Necrotizing soft tissue infection is the most serious of all soft tissue infections. The patient’s life is dependent on prompt diagnosis and aggressive treatment. Diagnostic delays are related to increased morbidity and mortality, and the risk of under- or missed diagnosis is high due to the rarity of the condition. There is a paucity of knowledge regarding early indications of disease. The aim of the study has thus been to explore patients’ and families’ experiences of early signs and symptoms and to describe their initial contact with the healthcare system.

A qualitative explorative design was used to gain more knowledge about the experience of early signs and symptoms. Fifty-three participants from three study sites were interviewed. The framework method was used for data analysis.

Most of the participants experienced treatment delay and contacted healthcare several times before receiving correct treatment. The experience of illness varied among the participants depending on the duration of antecedent signs and symptoms. Other important findings included the description of three stages of early disease progression with increase in symptom intensity. Pain experienced in necrotizing soft tissue infections is particularly excruciating and unresponsive to pain medication. Other common symptoms were dyspnea, shivering, muscle weakness, gastrointestinal problems, anxiety, and fear.

Our study adds to the understanding of the lived experience of NSTI by providing in-depth description of antecedent signs and symptoms precipitating NSTI-diagnosis. We have described diagnostic delay as patient-related, primary care related, or hospital related and recommend that patient and family narratives should be considered when diagnosing NSTI to decrease diagnostic delay.

• Diagnosis
• Family perspective
• Necrotizing soft tissue infection
• Patient experiences
• Qualitative study
• Signs and symptoms

Necrotizing fasciitis is an uncommon and potentially fatal infection that can affect the epidermis, dermis, and more commonly the subcutaneous, fascia, and muscle layers. NF is usually caused by toxin-producing bacteria with a relatively fast progression associated with severe surrounding tissue destruction. Early diagnosis and management are crucial factors for survival. Broad-spectrum antibiotics along with surgical debridement, sometimes multiple, are needed in order to stop or slow down the progression of NF. Despite optimal care, necrotizing fasciitis remains a highly morbid condition with a high mortality rate. We present a case of a 28-year-old male patient with rapidly developing fatal A. baumannii associated with necrotizing fasciitis, after open reduction and internal fixation (ORIF) of multiple fractures after polytrauma.

• clinical evaluation and treatment
• infectious diseases of the skin
• skin diseases

• LRINEC score
• Necrotizing fasciitis
• Outcomes
• Prognosis
• SOFA score
• Sepsis

Necrotizing fasciitis (NF) is a fatal aggressive infectious disease. We aimed to assess the major contributing factors of mortality in NF patients.

A retrospective study was conducted at a single surgical intensive care unit between 2000 and 2013. Patients were categorized into 2 groups based on their in-hospital outcome (survivors versus non-survivors).

During a14-year period, 331 NF patients were admitted with a mean age of 50.8 ± 15.4 years and 74 % of them were males Non-survivors (26 %) were 14.5 years older (p = 0.001) and had lower frequency of pain (p = 0.01) and fever (p = 0.001) than survivors (74 %) at hospital presentation. Diabetes mellitus, hypertension, and coronary artery disease were more prevalent among non-survivors (p = 0.001). The 2 groups were comparable for the site of infection; except for sacral region that was more involved in non-survivors (p = 0.005). On admission, non-survivors had lower hemoglobin levels (p = 0.001), platelet count (p = 0.02), blood glucose levels (p = 0.07) and had higher serum creatinine (p = 0.001). Non-survivors had greater median LRINEC (Laboratory Risk Indicator for NECrotizing fasciitis score) and Sequential Organ Failure Assessment (SOFA) scores (p = 0.001). Polybacterial and monobacterial gram negative infections were more evident in non-survivors group. Monobacterial pseudomonas (p = 0.01) and proteus infections (p = 0.005) were reported more among non-survivors. The overall mortality was 26 % and the major causes of death were bacteremia, septic shock and multiorgan failure. Multivariate analysis showed that age and SOFA score were independent predictors of mortality in the entire study population.

The mortality rate is quite high as one quarter of NF patients died during hospitalization. The present study highlights the clinical and laboratory characteristics and predictors of mortality in NF patients.

• Management
• Mortality
• Necrotizing fasciitis
• Predisposing factors
• Presentation

Liver cirrhosis is a risk factor for necrotizing fasciitis (NF), and is associated with markedly worse outcomes than for NF among non-cirrhosis patients. Only limited, mostly single-center, data were reported to date on the epidemiology, clinical features, resource utilization and outcomes of NF among patients with cirrhosis.

We studied a population-based cohort of adult hospitalizations associated with cirrhosis, who had a diagnosis of NF during the years 2001 - 2010, using the Texas Inpatient Public Use Data File. The annual volume of NF hospitalizations was benchmarked against all annual hospitalizations with a diagnosis of cirrhosis. The patterns of demographics, chronic comorbidities, evolving organ failure, resource utilization and outcomes were examined.

There were 371,745 hospitalizations associated with liver cirrhosis, with 381 NF hospitalizations during study period. The annual volume of NF hospitalizations rose 7.9%/year (P = 0.0287), while its incidence among cirrhosis-associated hospitalizations remained unchanged (P = 0.2955). Non-cirrhosis comorbidities were reported in 69.6% and ICU care was required in 67.2% of NF hospitalization. The key changes noted between 2001 - 2003 and 2008 - 2010 among NF hospitalizations included rising mean (SD) Deyo-Charlson index 2.4 (1.5) vs. 3.9 (2.4) (P < 0.0001), development of ≥ 3 organ failures in 9.1% vs. 39.8% (P < 0.0001), and discharge to long-term care facilities 7.8% vs. 21.1% (P = 0.0204). Hospital mortality was unchanged (26% vs. 33.1%; P = 0.3659). Inflation-adjusted total hospital charges did not change (P = 0.1025) during study period.

The present cohort of NF associated with liver cirrhosis is the largest reported to date. A rising annual volume of NF events matched a corresponding increase in cirrhosis-associated hospitalizations. There was increasing burden of chronic comorbidity and rising severity of illness, with a majority of patients requiring ICU care. Case fatality was high and there has been increasing residual morbidity among hospital survivors. The observed findings warrant further study in other populations.

• Cirrhosis
• Mortality
• Necrotizing fasciitis
• Organ failure
• Resource utilization