Scientific paperBurn center management of necrotizing soft-tissue surgical infections in unburned patients
Section snippets
Material and methods
This study was carried out with the approval of the Institutional Review Board of the University of Utah Health Center.
Results
We identified 57 patients during the study period, 18 of which were diagnosed with FG and 39 with NF. Six of these patients have been described previously [8]. Patients had a mean age of 51.8 ± 1.9 years (range 18 to 80). Twenty-nine patients (51%) were male, including 11 with FG (61%) and 18 with NF (46%). Mortality during acute care was 12% (7 of 57 patients). Length of hospitalization was 28.5 ± 2.2 days (range 3 to 70) for survivors, and 10.7 ± 4.1 days (range 1 to 32) for nonsurvivors.
Comments
This report reviews our experience with burn center treatment of necrotizing soft-tissue surgical infections. Necrotizing fasciitis is a relatively uncommon soft-tissue infection caused by toxin-producing organisms. Clinical characteristics include widespread and rapidly progressive fascial necrosis with sparing of the overlying skin and underlying muscle. The etiology is usually unknown; and introduction of the pathogen can occur by the disruption of intact skin as a result of a minor cut,
Discussion
Dr. John B. Cone (Little Rock, AR): First of all, your patient population demonstrated a relatively low incidence of alcohol, tobacco, and drug use compared to our burn center population, which has about 70% incidence of use of those substances. Is that something unique to the Utah population and does it account, in any way, for your improved survival?
Secondly, and perhaps of most importance, we all believe that we know that immediate surgery for debridement of these patients improves morbidity
Closing
Dr. Lee D. Faucher: At our institution, there are two dedicated burn physicians and they took care of all of the 57 patients that I mentioned. There were some smaller groups of patients that I recall taking care of that had simple arm necrotizing infections that were managed and cared for by some of the general surgeons, but the majority of other patients that we see at our institution are transferred to the burn center for definitive care.
It’s not for the surgeon’s sake, but for the patient’s
References (24)
- et al.
Necrotizing Group A streptococcal infections associated with streptococcal toxic shock syndrome
Am J Surg
(1996) - et al.
Necrotizing fasciitis due to group A streptococci in western Norwayincidence and clinical features
Lancet
(1994) Fournier’s gangrene
Surg Clin North Am
(1994)- et al.
Multidisciplinary team approach to the pediatric burn patient
Qual Rev Bull
(1988) - et al.
Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy
Surgery
(1999) Should we regionalize major surgery? Potential benefits and policy considerations
J Am Coll Surg
(2000)New York State Health Department communicable disease fact sheet
(1998)Flesh-eating bacterianot new, but still worrisome
Science
(1994)Necrotizing fasciitis, hospital gangrene, and phagedena
Lancet
(1994)The features and aetiology of Fournier’s gangrene
Postgrad Med J
(1994)
Fournier’s gangrene
Br J Urol
Determinants of mortality for necrotizing soft-tissue infections
Ann Surg
Cited by (70)
A Systematic Review and Meta-Analysis of the Effectiveness of LRINEC Score for Predicting Upper and Lower Extremity Necrotizing Fasciitis
2022, Journal of Foot and Ankle SurgeryPredisposing factors of necrotizing fasciitis with comparison to cellulitis in Taiwan: A nationwide population-based case–control study
2020, Journal of the Formosan Medical AssociationCitation Excerpt :Moreover, we identified age, stroke, chronic kidney disease, liver cirrhosis, tuberculosis as independent predictors of mortality among NF patients using multivariable analysis. About 20%–50% of NF patients were diabetic, and many previous studies had identified diabetes mellitus as a risk factor of NF.25,31–34 Other reported comorbidities or predisposing conditions associated with NF included obesity,25,31–34 hypertension,33,34 smoking,25,34 alcoholism,33 chronic renal disease,25 chronic liver disease,24,32 heart disease,33 and prescription of NSAID.35
Are we headed for a shortage of burn care providers in Canada?
2018, BurnsCitation Excerpt :On one hand, the incidence and severity of burns appears to be declining [19]; however, the provision of high quality burn care necessitates a certain number of practitioners in the workforce who are experts in the field. Beyond this, burn surgeons working in specialized centres demonstrate value added with improved outcomes in necrotizing soft tissue infections [20–22], exfoliative skin conditions [23], as well as emerging complex wound problems such as levamisole-associated skin necrosis [24]. Thus, maintaining a supply of burn surgeons experienced in critical care and wound management can offer the services of a “wound intensive care unit” [25], in addition to traditional burn care.
Laboratory risk indicators for necrotizing fasciitis and associations with mortality
2014, Turkiye Acil Tip DergisiCitation Excerpt :The mortality rate in our study (24%) was consistent with the literature[3,4,9,20] Clayton et al.[22] presented that mortality is significantly lower in young patients, in patients with BUN of 50 mg/dl or below, and in patients without ongoing sepsis. Faucher et al.[5] proposed that co-morbid diseases do not affect mortality. On the other hand, Francis et al.[23] proposed that mortality is 50% in patients with 3 or more risk factors (being 50 years old or older, diabetes, malnutrition, hypertension, or intravenous drug abuse).
Development and validation of a necrotizing soft-tissue infection mortality risk calculator using nsqip
2013, Journal of the American College of SurgeonsTrends in 393 necrotizing acute soft tissue infection patients 2000-2008
2012, BurnsCitation Excerpt :The first observation was that the number of patients treated for NASTI at our institution increased annually. This trend has been noted by other institutions that analyzed the number of cases per year, however, these were either large volume referral centers or they only report incidence of infection by specific organisms [1,16,17,25–28]. Most larger retrospective reviews did not report the yearly incidence, only total number of cases.