Hyperacute soft tissue infection in diabetics

ABSTRACT

Hyperacute soft tissue infection is an uncommon infection entity, which mostly affects immunocompromized individuals, mainly diabetics and poses difficult diagnostic and therapeutic management decision. This study addresses the presentation, evaluation and management of 27 diabetic patients with acute necrotizing fasciitis treated throughout the period between August 1993 and July 2003 by the main author. Extremities, trunk and perineum were the most commonly involved sites with an incidence of 37%, 29.6% and 26% respectively. All patients presented with cellulitis, which was associated with edema in 74% of cases, skin gangrene in 48% of cases and brown echymotic patches in 29.6% of cases. skin vesicles, tenderness and creiitations were present in 15%, 11% and 11% of cases respectively. Streptococci, Staphylococci and E-Coli were the most commonly encountered organisms, which affected 70% of cases, either alone or in combination. Anaemia and hypoalbuminaemia were the most commonly encountered laboratory findings in 74% and 85% of cases respectively. The mortality rate in the27 patients included in this study was 44% [12 cases]; in 8 of them infection was located in the truk. Once necrotizing fasciitis is suspected, exploration of the fasica is mandatory with pathological assessment of tissue specimens. Radical debriement of the affected area, maintenance of adequate nutritional support and systemic antibiotic therapy should be implemented at once to reduce mortality and insure safe recovery of patients