NECROTIZING FASCIITIS – RISK PROFILE AND OUTCOME

Abstract

Necrotizing fasciitis is a definition of a specific histopathology, the pathogenesis and clinical features vary broadly. Symptomatically is the severe invasive infection of the soft tissues with high rates of patient morbidity and mortality. Beside the most common identified bacteria as A Streptococci (GAS), other bacteria are identified such as gram-positive or-negative bacteria or mixed infections. The aim of the following study was to analyze the specific predisposing risk factors and outcome of patients suffering necrotizing fasciitis.

Methods: The data of patients suffering necrotizing fasciitis were prospective collected since 2004. Criteria were the clinical and histological evidence of a necrotizing fasciitis. The clinical course, concomitant diseases, detectable bacteria and outcome with focus on limb salvage, amputation rates and hospital mortality was analyzed. Primary focus of the therapeutic regimen was the surgical and intensive care therapy. Adjuvant therapy was the hyperbaric oxygen therapy.

Results: 55 patients were prospective enrolled in the study with the clinical and histological diagnosis of a necrotizing fasciitis from 2004–2008. The mean age of the patients was 58 ± 15 years at the timepoint af admission to the hospital. Gender distribution was 68 % male and 32 % female. 87 % of these patients were admitted after interhospital transfer. 82 % were admitted to the intensive care unit and 78 % needed catecholamines. The hospital mortality was 31 %. The ranking list of potential risk factors in descending frequency was: diabetes, obesity, immunosupression of different causes. Affected were in 22 % of the cases the upper extremities, 72 % lower extremities and/or in 12 % the trunk. In 80 % of the deceased patients the pelvic region or the trunk was involved. Almost half of the patients suffered an amputation of one limb.

Summary: The necrotizing fasciitis remains an interdisciplinary challenge for specialized centers providing the logistical infrastructure for the treatment of these patients. Despite the optimal treatment options and additional therapy with hyperbaric oxygen therapy the hospital mortality remains high. Prognostic unfavorable is the involvement of the trunk and pelvic region. Typical risk factors are described above. The analysis of pathogenic bacteria shows a broad variety and gives no clear hints in the diagnosis or prognosis of the fasciitis. Crucial for the surgery and indication for limb amputations as a salvage procedure is the clinical course.