Early diagnosis and treatment of necrotizing fasciitis can improve survival: an observational intensive care unit cohort study. (19th September 2012)

• Record Type: Journal Article
• Authors: Bucca, Kelly; Spencer, Ryan; Orford, Neil; Cattigan, Claire; Athan, Eugene; McDonald, Anthony
• Is Part Of: ANZ journal of surgery. Volume 83:Number 5(2013)
• Page Start: 365
• Page End: 370
• Publication Date: 2012-09-19
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1111/j.1445-2197.2012.06251.x
• Languages: English
• ISSNs: 1445-1433

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="ans6251-sec-0001" sec-type="section"> <title>Background</title> <p>The aim of this study was to describe the clinical characteristics, causative pathogens, clinical management and outcomes of patients presenting to a tertiary adult Australian intensive care unit (ICU) with a diagnosis of necrotizing fasciitis (NF).</p> </sec> <sec id="ans6251-sec-0002" sec-type="section"> <title>Methods</title> <p>This retrospective observational study was conducted in a 19‐bed, level III, adult ICU in a 450‐bed tertiary, regional hospital. Clinical databases were accessed for patients diagnosed with NF and admitted to The Geelong Hospital ICU between 1 February 2000 and 1 June 2011. Information on severity of sepsis, surgical procedures and microbiological results were collected.</p> </sec> <sec id="ans6251-sec-0004" sec-type="section"> <title>Results</title> <p>Twenty patients with NF were identified. The median age was 52.5 years and 38% were female. The overall mortality rate was 8.3%. Common co‐morbidities were diabetes (21%) and heart failure (17%), although 50% of patients had no co‐morbidities. Group A <italic>Streptococcus</italic> was the identified pathogen in 11 (46%) patients, and <italic>Streptococcus milleri</italic> group in 5 (21%) patients. Hyperbaric oxygen therapy was not used in the majority of patients. The initial antibiotics administered were active against subsequently cultured bacteria in 83% of patients. Median time to surgical debridement was 20 h. Diagnosis and management was delayed in the nosocomial group.</p> </sec> <sec id="ans6251-sec-0005" sec-type="section"> <title>Conclusions</title> <p>This study reports physiological data, aetiology and therapeutic interventions in NF for an adult tertiary hospital. We demonstrate one of the lowest reported mortality rates, with early surgical debridement being achieved in the majority of patients. The main delay was found to be in the diagnosis of NF.</p> </sec> </abstract>