The study of the prognostic outcome of necrotizing fasciitis patients with and without diabetes mellitus (original) (raw)
Related papers
Necrotizing fasciitis and its association with Diabetes Mellitus
Qatar medical journal, 2009
To analyze the different presentation, types of infection, predisposing factors (particularly diabetes mellitus) of necrotizing fasciitis; a rare potentially fatal rapidly progressing necrotizing infection of subcutaneous tissue and superficialfascia with secondary necrosis of overlying skin, the medical records were reviewed retrospectively of 94 patients (71 male; 23 female) admitted to the surgical intensive care unit of Hamad General Hospital, Qatar, between January 1995 and February 2005. Fifty-three patients (56.4%) were diabetic with a mean age of 55 years compared with 40.2 years in non-diabetic patients. Type 1 necrotizing fasciitis, especially of the perineal and genital regions, was more common in diabetic patients whereas type 2 necrotizing fasciitis, especially of torso and upper limbs, was more common in non-diabetic patients. Overall 63.4% of cases were type 2 necrotizing fasciitis. E.coli was the most common bacterium isolated from necrotic tissue of diabetic patients and streptococci were the most common cause of necrotizing fasciitis in non-diabetic patients. Fifteen (16%) patients died but there was no significant difference in mortality between the groups, eight (15.1%) diabetic, seven (17.1%) non-diabetic, although diabetic patients were significantly older.
Diabetes mellitus and necrotizing fasciitis – a deadly combination; case report
Journal of Mind and Medical Sciences
Necrotizing fasciitis is a rapidly destructive affliction of soft tissues, with a mortality rate that may reach 73% of the cases. It is characterized by a progressive inflammation and extended necrosis of the subcutaneous tissue and the fascia. Necrotizing fasciitis was first described in 1848, and later in 1920 Meleney identified 20 patients in China in which the infection was presumably triggered by hemolytic streptococcus, linking pathological bacteria to the condition. In 1952, Wilson coined the term necrotizing fasciitis although without successfully identifying the specific pathological bacteria involved. In most cases, both risk and aggravating factors are present, the main risk factors being diabetes mellitus, liver cirrhosis, renal failure, and immunosuppressant states. Location may vary, but most frequently the disease occurs in the limbs, the trunk, and the perineum. Treatment depends on the location and the time of diagnosis and may range from large incisions with extensive debridement to organ amputations such as those of the limbs or breasts. Treatment is complex and expensive, and besides surgery, includes the administration of broadspectrum antibiotics, anti-inflammatory drugs, intensive therapy support, and long-term hospitalizations. The prognosis is guarded. The present case entails a 56-year old female patient who presented with many risk factors favoring the occurrence of necrotizing fasciitis, namely diabetes mellitus, liver cirrhosis (decompensated with ascites and portal encephalopathy phenomena), untreated hepatitis B infection, chronic renal failure with diabetic nephrotic syndrome, and obesity.
Management of necrotizing fasciitis in diabetic patients
Journal of Diabetes and its Complications, 2007
Necrotizing fasciitis is a life-threatening condition in diabetic patients; its management and salvage of the patient is a formidable challenge. Diabetes mellitus is one of the serious conditions associated with necrotizing fasciitis. It is a disorder that primarily affects the microvascular circulation.
Surgical Outcome of Necrotizing Fasciitis in Diabetic Lower Limbs
Necrotizing fasciitis is a life and limb threatening soft tissue infection. It is one of the most aggressive forms of soft tissue infection. As the incidence of diabetes mellitus is increasing world wide, this rare infection is now on the rise in developing countries. Necrotizing fasciitis has a very high mortality rate. We reviewed retrospectively 44 diabetic patients who were operated for necrotizing fasciitis of the lower limb over a period of 1 year. Around 26.4% of our patients with necrotizing fasciitis underwent major amputations. The mortality due to necrotizing fasciitis in diabetic lower limbs at our institute was 6.81%. This is on the lower side as compared to that reported in the literature. This series of necrotizing fasciitis in diabetic lower limbs over 1 year period is among the largest series reported.
An Atypical Manifestation of Necrotizing Fasciitis in a Patient With Type II Diabetes
Curēus, 2024
In this case report, we discuss a 32-year-old diabetic male patient who presented with right foot pain three days following a spider bite. The foot progressively became swollen, preventing the patient from bearing weight on it. After admission to the emergency department, the examination showed discoloration of the dorsum of the proximal phalanx of the first toe with an open wound and pus. The patient received fluid resuscitation along with a course of metronidazole and levofloxacin. Subsequently, the patient was referred to an orthopedic and podiatric team where he underwent a complete foot fasciotomy. The procedure was successful, and the patient recovered well. This case showcases a rare manifestation of necrotizing fasciitis (NF) and highlights the importance of future research regarding NF and its association with diabetes mellitus.
Lower Extremity Necrotizing Fasciitis in Diabetic and Nondiabetic Patients: Mortality and Amputation
The International Journal of Lower Extremity Wounds, 2019
Lower extremity necrotizing fasciitis (NF) is a severe infection requiring immediate surgery. The aim of this study was to assess patient factors predictive of amputation and mortality in diabetes mellitus (DM) and non-DM patients with lower extremity NF. The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was reviewed retrospectively. Out of 674 patients with lower extremity NF, 387 had DM (57.4%). Patients with DM had lower mortality ( P = .004). Increased mortality was independently associated with age >60 years (adjusted odds ratio [aOR] = 3.96, 95% confidence interval [CI] = 1.69-9.77), partial thromboplastin time >38 seconds (aOR = 2.66, 95% CI = 1.09-6.62), albumin <2.0 mg/dL (aOR = 2.84, 95% CI = 1.13-7.37), coagulopathy (aOR = 3.29, 95% CI = 1.24-9.19), higher anesthesia risk category (aOR = 3.08, 95% CI = 1.18, 8.59), chronic obstructive pulmonary disease (aOR = 3.46, 95% CI = 1.13-10.9), postoperative acute respirat...
Turkish Journal of Trauma and Emergency Surgery
BACKGROUND: Necrotizing fasciitis is a rapidly progressing, potentially fatal soft-tissue infection that spreads through the fascia. Due to the late onset of diagnostic signs during the disease's advanced stage and its rapid progression, it can be challenging to make a prompt diagnosis. However, with a rapid and accurate diagnosis, the progression of the disease can be halted through appropriate early surgical intervention. Even with correct and timely treatment, the mortality rate for necrotizing fasciitis is higher compared to other soft-tissue infections. This study aims to investigate the effects of clinical parameters in patients with necrotizing fasciitis on mortality. METHODS: The study included 37 patients with a necrotizing fasciitis diagnosis between 2009 and 2018. Demographic characteristics of the patients (age, gender, comorbid conditions), duration from diabetes diagnosis if present, blood glucose level at the time of diagnosis, microorganisms isolated from wound cultures, presence of positive blood cultures, administered antibiotic therapy, laboratory risk indicator for necrotizing fasciitis (LRINEC) score at presentation, number and types of surgical procedures performed, length of hospital stay, and mortality rates were retrospectively recorded. Statistical analysis of dependent and independent variables was conducted using t-tests, Mann-Whitney U test, Chi-square test, and Fisher's exact test. RESULTS: Age was found to be an average of 70 in the mortality group, and it is significantly higher compared to the non-mortality group. A high LRINEC score, the presence of comorbidity, and a positive blood culture were also found to be significant in the mortality group. The low number of surgical procedures performed is significantly lower in the mortality group. CONCLUSION: This study highlights the conditions associated with high mortality in patients with necrotizing fasciitis, which is a treatable disease through timely and accurate diagnosis followed by appropriate antibiotic therapy and surgical intervention. It emphasizes the importance of updating the approach for high-risk group patients and aims to provide information that will help lower the threshold for diagnosing necrotizing fasciitis.
Objectives: Necrotizing fasciitis is a life-threatening soft-tissue infection primarily involving the superficial fascia. The present study describes the clinical presentation and microbiological characteristics of this condition as well as risk factors, management and outcome of the patients. Materials and Methods: In this prospective study, tissue and/or wound swabs and blood for culture from 50 clinically suspected cases were cultured aerobically and anaerobically and the isolates tested for sensitivity. Clinical correlation and follow-up was done. Results: The age range was 17-87 years (mean=54 yrs) with a male predominance. The most common site of infection was the calf region (59.5%) and diabetes mellitus was the most common associated comorbidity (44.7%). Majority of the patients presented with symptoms of sepsis, systemic toxicity, or evidence of skin inflammation. Hyperacute cases presented with sepsis and quickly progressed to multiorgan failure (40%). 23 patients (57.5%) ...