Takahito Miyake (Gifu-shi / JP), Hideshi Okada (Gifu-shi / JP), Norihide Kanda (Gifu-shi / JP), Yosuke Mizuno (Gifu-shi / JP), Tomotaka Miura (Gifu-shi / JP), Fuminori Yamaji (Gifu-shi / JP), Tetsuya Fukuta (Gifu-shi / JP), Shozo Yoshida (Gifu-shi / JP), Shinji Ogura (Gifu-shi / JP)
Abstract text (incl. references and figure legends)
【Introduction】 Necrotizing fasciitis (NF), a life-threatening soft tissue infection, develops rapid and requires repeated surgery including debridement or amputation. This study aimed to assess the treatment and prognosis of NFs and investigate the need for major amputations.
【Materials and methods】We included patients with NF treated at the Advanced Critical Care Center, Gifu University Hospital, during a 13-year period (April 2009 to December 2021). Their charts were reviewed and data were analyzed in terms of demographic and microbiological characteristics and therapeutic course including operations and mortality.
【Results】This study included 32 patients (men: 27 and women: 5) with an median age of 60 (IQR: 46.3–72.5) years. 13 patients had diabetes mellitus and 2 had rheumatic arthritis and used steroids. The median laboratory risk indicator necrotizing fasciitis was 8 (6.25–8.25), and 18 (8–68) mg/dL. Streptococcus species were the most detected bacteria, and 27 patients were treated with carbapenem. The median antibiotic duration was 24.5 (IQR: 15–33.3) days. All patients underwent debridement operation on day 1, and the median number of surgical interventions was 2 (1–8). 3 patients underwent major thigh amputation. Three patients died (mortality rate: 9.4%).
【Discussion】The mortality and major amputation rates (9.4% and 9.4%, respectively) were lower than those reported previously. In this study, even when patients had multiple organ failure or septic shock, major amputation was not always needed because of effective communication between the infection control team and intensive care specialists, resulting in radical debridement without amputation.
【Conclusion】A multidisciplinary approach can be an effective strategy for lowering mortality and amputation rates in patients with NF.
【Reference】
Pelletier J, et al, :Necrotizing Soft Tissue Infections (NSTI): Pearls and Pitfalls for the Emergency Clinician. J Emerg Med. 2022 Apr;62(4):480-491.
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