title: A five-year review of necrotising fasciitis in a tertiary referral unit.
abstract: BACKGROUND
  Necrotising fasciitis is a life-threatening illness that is often difficult to diagnose. Immediate debridement and intravenous antibiotic therapy are required to limit the spread of infection. This five-year audit aimed to review the number and outcomes of all cases of  necrotising fasciitis admitted to a tertiary referral unit and to assess the validity of the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scoring system.
  
  
  METHODS
  A retrospective analysis of patient notes over the five-year period from October 2006 to October 2011 was undertaken.  The LRINEC score was calculated for each patient to evaluate its usefulness.
  
  
  RESULTS
  Overall, 15 patients were diagnosed with necrotising fasciitis. Three patients died. The median age of patients was 51.0 years (range: 34-76 years). There were no obvious predisposing factors in  8 cases but patients had a median of 2.0 co-morbidities. The most common infective agent, present in five patients, was Group A Streptococcus. Other monomicrobial agents included Group G Streptococcus and Klebsiella pneumoniae. Polymicrobial infections were less common  than mono-microbial infections and two patients had a polymicrobial infection including methicillin-resistant Staphylococcus aureus. Although the LRINEC scoring system identified 12 of the 15 patients as having a high or intermediate likelihood of necrotising fasciitis, 3 were classified  as low likelihood.
  
  
  CONCLUSIONS
  This limited case series strongly suggests that the LRINEC system is too insensitive for diagnosis.
authors: Imperial College London, UK.
authors: R A
authors: RA
authors: Swain
authors: J C
authors: JC
authors: Hatcher
authors: B S
authors: BS
authors: Azadian
authors: N
authors: N
authors: Soni
authors: B
authors: B
authors: De Souza
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement / Q000706:statistics & numerical data; D042241:Early Diagnosis; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D061665:Time-to-Treatment
chemical_list: D000900:Anti-Bacterial Agents; D016756:Immunoglobulins, Intravenous