Necrotizing Fasciitis: Analysis of the Clinical, Microbiological Pattern, and Factors Associated with Mortality

Abstract

Background: Necrotizing fasciitis is a life-threatening rapidly progressing bacterial infection associated with necrotic changes of the superficial fascia, subcutaneous tissue, and the deep fascia. It is a surgical emergency requiring a high suspicion, early diagnosis, and early treatment. We aim to analyze the clinical and microbiological pattern of necrotizing fasciitis and to determine factors associated with mortality. Methods: A prospective cohort study of the results of 476 patients who were diagnosed and treated for necrotizing fasciitis between January 2005 and December 2014in Al Ansar general public health hospital in Medina, Saudi Arabia was done. Results: Age ≥ 40 years was found statistically to be associated with developing necrotizing fasciitis for both males and females. The majority of the patients had involvement of the lower limb; 31.7% in the right calf and 29.8% in the left calf. Soft tissue infection in 24.4% of the patients was the most common etiology. The most common organism isolated in the monomicrobial infection was Beta-hemolytic Streptococcus in 46.7% of the patients, and the most common organism isolated in the polymicrobial infection was Staphylococcus aureus in 72.8% of the patients. Surgical debridement was done to all patients (100%). The mortality rate was (7.1%). Acidosis (p ˂ 0.05) and hypoalbuminemia (p ˂ 0.05) were the significant factors for mortality. Conclusion: The aggressive course of necrotizing fasciitis could lead to considerable morbidity and mortality. Acidosis and hypoalbuminemia were found to be factors strongly associated with high mortality. Other possible factors include truncal location (from the neck to the pelvic region) and leukocytosis.