NECROTISING FASCIITIS : PREVELANCE AND DISTRIBUTION OF CAUSATIVE MICROORGANISM IN A MALAYSIA TERTIARY HOSPITAL - A 2 YEAR STUDY

The objective of this study was to evaluate the prevalence of microorganism isolates types, antibiotic usage preference, the prevalence of diabetic amputations in necrotizing fasciitis (NF) and predicitive factors of amputation. Methodology: This study was a cross-sectional study conducted by looking at medical records ttraced from Hospital Seremban identifying all necrotizing fasciits admissions in the year of 2017/2018. The researchers first traced all medical records via electronic medical records. All case records were reviewed and identifiers were removed. Patients with missing notes/medico-legal cases were excluded from this study. Results: A total of 159 records were traced of which none met the exclusion criteria. The mean age of patients were 56.09 (SD:12.20), mean days stayed at hospital 25.09 (17.70) and the mean number of days patients were on at least one antibiotic was 18.87 (41.78). From the total, 145 (91.2%) were suffered at the lower limbs, 68 (42.8%) suffered an amputation [of which 31 were above-knee-amputations], 97 (61.0%) suffered from sepsis and 19 (11.9%) suffered mortality. 139 (87.4%) of the patients were diabetics, 105 (66.0%) were hypertensives and 87 (54.7%) were immunocompramised. The majority were caused by unknown aetiology [103 (64.8%)], 131 (82.4%) presented with erythema/cellulitis and 116 (73.0%) had good prognosis. The commonest type of NF was type 2 [103 (64.8%)]. The top 3 commonest isolates were Pseudomonas aeruginosa (15.7%), Klebsiella pneumoniae (12.6%) and β haemolytic Group B Streptococcus (10.7%). The 3 commonest antibiotics started were ampicillin/sulbactam combination (69.8%), ceftazidime (9.4%) and amoxycillin/clavulanate (4.4%). The mean LRINEC score was 7.72 (SD:2.31). Among the 139 diabetics, 68 (48.9%) ended up with an amputation. Among the 102 patients having both diabetes and hypertension (n=102), 50% suffered an amputation. A cross tabulation done showed that Klebsiella pneumoniae (17.2%), β haemolytic Group B Streptococcus (15.5%) and Proteus mirabillis (13.8%) were the common causative organisms in an amputation. A regression analysis done to identify predictive variables for an amputation showed no statistical significant variables. Conclusion: Proper handling of seafood during preparation should be encouraged as a simple bite may turn deadly. Initiation of antibiotics according to suspected organisms should be performed to prevent worsening of soft tissue infections. Conclusion: From this study, we concluded that the commonest type of isolates at our centre was Pseudomonas aeruginosa and the commonest antibiotic choice was the ampicillin/sulbactam combination and nearly half of diabetics with NF ended up with an amputation. There were no predictive factors for an amputation among the collected variables