Necrotising infections of soft tissues--a clinical profile

Abstract

Objective: To study the clinical profile and outcome of patients with necrotising soft-tissue infections.

Design: Prospective study.

Setting: Teaching hospital, India.

Subjects: 75 patients (54 male and 21 female), mean age 40 years (range 8 months-85 years).

Interventions: Patients were uniformly managed by initial resuscitation, debridement, topical wound care, systemic antibiotics, and enteral hyperalimentation.

Main outcome measures: Morbidity and mortality.

Results: Aetiology of the infections included major and minor trauma, minor skin infections and postoperative infections. 22 patients were diabetic. The extremities were involved in 57 patients, the trunk in 26 and the perineum in 21. 68 presented with local tenderness (91%), 74 with oedema (99%), 54 with erythema (72%), 55 with ulceration (73%), and 54 with a purulent or serous discharge (72%). beta-haemolytic streptococci were isolated from only 10 patients. Staphylococcus aureus was the most common bacteria isolated (n = 30, 46%) followed by Bacteroides fragilis and anaerobic cocci (n = 22, 34% each). Cultures grew fungi in 9 patients. 20 patients died giving a mortality of 27%. Jaundice and serum albumin were the only factors to have a significant influence on mortality.

Conclusions: Necrotising soft tissue infections are potentially fatal. Early recognition and prompt aggressive debridement are the keys to successful management.