Necrotizing Soft-Tissue Infection and Necrotizing Fasciitis in Adults of a Single Center: Review, Current Concepts and Challenges

Background: The aim of this work is to assess the clinical and therapeutic characteristics of patients treated for necrotizing soft-tissue infection/necrotizing fasciitis (NSTI/NF) and determine their outcomes. Patients and Methods: During the period 1/2012-12/2019 24 adults (18 males, 6 females, aged 33-91 years/mean age 52.4 years) with NSTI/NF were treated. Comorbidities were encountered in 20 (83.3%). Eighteen patients (Group I) presented late, with gangrene and systemic inflammatory response syndrome (9) or septic shock/ organ dysfunction (9). Six patients (Group II) presented early, with local pain, fever, and erythema. Affected areas included perineum-scrotum- external genitalia- abdominal wall or thigh, extremities-trunk, and gluteofemoral area in Group I, and scrotum, extremities, and labium majus in Group II. Results: Intensive resuscitation and antibiotics were started immediately. All patients had a CT scan and underwent surgery within 4 hours from admission. All necrotic soft tissues were aggressively excised. Additionally, patients underwent Hartmann’s colectomy (3) or colostomy (3), thoracostomy (1), opening of compartments of extremities (2), and extrapelvic drainage (1).Wounds were packed open; specimens were sent for Gram stain/cultures and histology. From Group I, 14 remained intubated for 2-10 days, and 15 required 1-5 further limited debridements or incisions (mean 2). Histologically, tissue necrosis was confirmed in all patients, NF in 18. Infection was polymicrobial in 20. Antibiotics were modulated based on culture results. Four Group I diabetics with extended perineal NF died due to uncontrolled sepsis (16.66%). Survivors received antibiosis for 10-18 days (mean, 15), were helped with nutritional support, and they had a planned wound closure or reconstruction. Their mean hospitalization was 28 days (range, 12-46). Conclusion: Improving diagnosis of NSTI/NF requires awareness for early recognition and prompt initiation of aggressive treatment, particularly for lesions extended beside perineum. Unfavourable outcome is affected by the delayed or inadequate surgery and the degree of multiple organ dysfunction on admission.