Dr. Chung Yat Kiu; Department of Medicine, Tseung Kwan O Hospital, Hong Kong
Objectives: To study the clinical features, spectrum of microorganisms, treatment and outcomes of necrotizing fasciitis (NF) patients who required intensive care unit (ICU) admission.
Methods: The medical records of 90 patients, who had been admitted to the intensive care units of Queen Elizabeth Hospital, United Christian Hospital and Tseung Kwan O Hospital due to necrotizing fasciitis from January 2005 to December 2011, were reviewed retrospectively.
Results: The study population consisted of 63 males and 27 females. The mean age of the patients was 61.4 (± 14.4) years. Diabetes was the most common comorbidity of NF. Majority of the cases were idiopathic in etiology (n=50; 55.6%). Extremities NF (n=67; 74.4%) occurred more frequently than central NF (n=23; 25.6%). Vibrio was the most prevalent microorganism isolated (n=20). The median time of diagnosis, counted from onset of symptoms, was 59 (42.8 – 82.0) hours. The median time of the first operation, counted from hospital admission, was 14 (6.1 – 26.0) hours. 76 patients had received surgical debridement. Amputation was performed in 43 cases. The median time of ICU admission was 14 (7.5 – 30.5) hours and the median APACHEⅡscore was 19 (15 – 23). Most patients developed disseminated intravascular coagulopathy (n=78; 86.7%). The ICU mortality was 34.4% (n=31) and the hospital mortality was 46.7% (n=42). The median length of stay in ICU was 9 (4 – 15) days and the median length of stay in hospital was 23.5 (12.8 – 49.0) days. The age, serum lactate, APACHEⅡscore were significantly higher in the non-survivors. The time of diagnosis and operation were significantly delayed in the non-survivors. Bacteraemia, debridement < 3 times, operation > 24 hours after admission and presence of organ failure were significantly associated with mortality.
Conclusion: Marine microorganism (Vibrio spp. and Aeromonas spp.) was the most prevalent type of microorganism found in this study. Early diagnosis, early operation and adequate surgical debridement were important in the management of NF. NF patient should receive debridement ≥ 3 times and the operation should be performed within 24 hours after admission, as they were shown to be associated with lower mortality in this study.