RISK FACTORS AND OUTCOMES IN PATIENTS WITH SEVERE NECROTIZING FASCIITIS ADMITTED TO SURGICAL INTENSIVE CARE UNIT: A RETROSPECTIVE COHORT STUDY FROM PAKISTAN

Authors

  • Muhammad Faisal Khan Department of Anaesthesiology, Aga Khan University Karachi-Pakistan
  • Akbar Azizullah Mistry Sindh Institute of Urology & Transplant Children and Cardiac Centre, Karachi-Pakistan
  • Ayesha Shabbir Usmani Department of Anaesthesiology, Aga Khan University Karachi-Pakistan
  • Faisal Shamim Department of Anaesthesiology, Aga Khan University Karachi-Pakistan http://orcid.org/0000-0001-5504-8341

DOI:

https://doi.org/10.55519/JAMC-S4-12426

Keywords:

Necrotizing fasciitis, Sepsis, Intramuscular injection, Mortality, LRINEC score

Abstract

Background: Necrotizing fasciitis (NF) is a debilitating condition that has high mortality and morbidity even in specialized centres. This study aims to determine risk factors in our local population and identify variables that contribute to mortality in the necrotizing fasciitis patients treated in the surgical intensive care unit of a tertiary care hospital Methods: This retrospective cross-sectional study included 39 patients admitted to the surgical ICU from January 1, 2015 to June 30, 2019. They were analyzed for comorbidities, symptoms at presentation, predisposing factors, location of the infection, microbiological analysis and mortality. Results: There were 27 (69.2%) males and 12 (30.8%) females while the age was distributed as 47.44±15 years. Pain was the most frequently reported symptom (89.7%), followed by swelling (79.5%) and tenderness (77%). Significant predisposing factors included trauma in 14 (35.9%) and  Intramuscular injections (IM) in 10 (25.6%) patients. On univariate and multiple logistic regression, patients with chronic kidney disease (AOR:1.27, 95% CI: 0-691.22) and ischemic heart (AOR: 1.55, 95% CI: 0.02-153.26) disease had higher odds of mortality than those with no comorbidity. The overall mortality was 12/39 (30.8%). Conclusion: Intramuscular injections without aseptic measures in our local population are a significant predisposing risk factor for severe necrotizing fasciitis. High laboratory risk Indicator for necrotizing fasciitis and acute physiology and chronic health evaluation II scores at admission were associated with increased mortality.

Author Biographies

Muhammad Faisal Khan, Department of Anaesthesiology, Aga Khan University Karachi-Pakistan

 

Akbar Azizullah Mistry, Sindh Institute of Urology & Transplant Children and Cardiac Centre, Karachi-Pakistan

 

Ayesha Shabbir Usmani, Department of Anaesthesiology, Aga Khan University Karachi-Pakistan

 

Faisal Shamim, Department of Anaesthesiology, Aga Khan University Karachi-Pakistan

 

References

Netzer G, Fuchs BD. Necrotizing fasciitis in a plaster-casted limb: case report. Am J Crit Care 2009;18(3):287–8.

Yaghubiian A, de Virgillio C, Dauphine C, Lewis RJ, Mathew L. Use of Admission Serum Lactate and Sodium Levels to Predict Mortality in Necrotizing Soft-Tissue Infections. Arch Surg 2007;142(9):840–6.

Wallace HA, Perera TB. Necrotizing Fasciitis. StatPearls Publishing, Treasure Island, FL; 2021.

Magala J, Makobore P, Makumbi T, Kaggwa S, Kalanzi E, Galukande M. The clinical presentation and early outcomes of necrotizing fasciitis in a Ugandan Tertiary Hospital- a prospective study. BMC Res Notes 2014;7:476.

Chen JL, Fullerton KE, Flynn NM. Necrotizing fasciitis associated with injection drug use. Clin Infect Dis 2001;33(1):6–15.

Kwan MK, Saw A, Chee EK, Lee CS, Lim CH, Zulkifle NA, et al. Necrotizing fasciitis of the lower limb: an outcome study of surgical treatment. Med J Malaysia 2006;61(Suppl A):17–20.

Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004;32(7):1535–41.

Persichino J, Tran R, Sutjita M, Kim D. Klebsiella pneumoniae necrotizing fasciitis in a Latin American male. J Med Microbiol 2012;61(Pt 11):1614–6.

Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg 2014;51(8):344–62.

Hua C, Bosc R, Sbidian E, De Prost N, Hughes C, Jabre P, et al. Interventions for necrotizing soft tissue infections in adults. Cochrane Database Syst Rev 2018;5(5):CD011680.

Cheng NC, Yu YC, Tai HC, Hsueh PR, Chang SC, Lai SY, et al. Recent trend of necrotizing fasciitis in Taiwan: focus on monomicrobial Klebsiella pneumoniae necrotizing fasciitis. Clin Infect Dis 2012;55(7):930–9.

Tena D, Arias M, Alvarez BT, Mauleon C, Jimenez MP, Bisquert J. Fulminant necrotizing fasciitis due to Vibrio parahaemolyticus. J Med Microbiol 2010;59(Pt 2):235–8.

Bechar J, Sepehripour S, Hardwicke J, Filobbos G. Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature. Ann R Coll Surg Engl 2017;99(5):341–6.

Park KH, Jung SI, Jung YS, Shin JH, Hwang JH. Marine bacteria as a leading cause of necrotizing fasciitis in coastal areas of South Korea. Am J Trop Med Hyg 2009;80(4):645–50.

Singh G, Sinha SK, Adhikary S, Babu KS, Ray P, Khanna SK. Necrotising infections of soft tissues--a clinical profile. Eur J Surg 2002;168(6):366–71.

Frazee BW, Fee C, Lynn J, Wang R, Bostrom A, Hargis C, et al. Community-acquired necrotizing soft tissue infections: a review of 122 cases presenting to a single emergency department over 12 years. J Emerg Med 2008;34(2):139–46.

Amiri FS, Foroughi A. Concurrent emphysematous pyelonephritis and thigh necrotizing fasciitis after intramuscular administration of diclofenac. Saudi J Kidney Dis Transpl 2014;25(6):1263–5.

Mendoza C, Salvo S, Luque P, Condado H, Gonzalo MA, Algarate S. Fascitis necrotizante y síndrome del shock tóxico por Streptococcus pyogenes tras inyección intramuscular [Necrotizing fasciitis and toxic shock syndrome due to Streptococcus pyogenes after intramuscular injection]. Rev Esp Quimioter 2019;32(5):473–4.

Lee EY, Ip WY. Necrotizing fasciitis of the extremity caused by Haemophilus influenzae serotype b in a healthy adult. Clin Orthop Relat Res 2010;468(5):1436–9.

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Published

2024-01-16