ABSTRACT
Background: Necrotizing soft tissue infection (NSTI) is a serious condition that can be diagnosed on a high index of suspicion and require urgent surgical treatment. NSTI involved epidermis and dermis but more frequently it affects the deeper layer of adipose tissue, fascia, and muscle. NSTI diagnosis and its treatment include emergent surgical intervention and the use of appropriate antibiotics. In this study, we have been evaluated the laboratory risk indicator for necrotizing fasciitis (LRINEC) score in predicting the outcomes in patients of NSTI.Methods: We have conducted a prospective study of 36 patients with NSTI. The LRINEC score, predisposing factors, etiology, risk factors, causative microbiological organisms have been studied.Results: LRINEC score >8 is associated with NSTI in all cases. The mortality and morbidity, length of stay including ICU stay increases with an increase in LRINEC score. The most common microorganism was found to be E. coli followed by Klebsiella.Conclusions: Although, we used the emergent and liberal debridement and appropriate antibiotic and resuscitation. In this study, morbidity, mortality, and length of hospital stay all are increased with respect to the increase in LRINEC score.
ABSTRACT
We present five patients with vibrio necrotising fasciitis, a lethal and disabling disease. Two of these patients had a history of exposure to either warm seawater or raw/live seafood, three had underlying chronic liver disease, and four presented with hypotension and fever. There were three deaths and four patients required intensive care unit stays. Among the two survivors, one had high morbidity. Only one patient met the criteria of Laboratory Risk Indicator for Necrotising Fasciitis score > 6. A clinician should suspect possible vibrio necrotising fasciitis if the following are present: contact with fresh seafood/warm seawater, a known history of chronic liver disease and pain that is out of proportion to cutaneous signs. All patients must be managed via intensive care in high dependency units. We recommend a two-step surgical protocol for patient management involving an initial local debridement, followed by a second-stage radical debridement and skin grafting.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Debridement , End Stage Liver Disease , Fasciitis, Necrotizing , Diagnosis , Microbiology , General Surgery , Fever , Hepatitis B , Hypotension , Retrospective Studies , Risk Factors , Seafood , Seawater , Severity of Illness Index , Singapore , Skin Transplantation , Vibrio , Vibrio Infections , Diagnosis , General SurgeryABSTRACT
BACKGROUND AND OBJECTIVES: Deep neck infection can occur at any age and is a potentially life-threatening diseases. However, an early recognition of aggravating infections is clinically difficult. In this study, we aimed to determine the Modified Laboratory Risk Indicator for Necrotizing Fasciitis (M-LRINEC) scores to predict aggravating deep neck infections. SUBJECTS AND METHOD: We retrospectively analyzed 72 patients with deep neck infection from January 2010 and December 2012 in a tertiary hospital. Differences in patient characteristics, radiographic findings, LRINEC scores, and M-LRINE scores were compared between the non-surgical group and the surgical group. RESULTS: The mean M-LRINEC scores were 4.35 and 1.39 in the surgical group and non-surgical group, respectively. Significant differences between the two groups were found in age, size of abscess, multiple spaces involvement, air collection, and mediastinitis. CONCLUSION: The M-LRINEC score is an useful indicator that signals the need to initiate early surgery and also to predict aggravating deep neck infections.