Necrotizing fasciitis: The need for urgent surgical intervention and the impact of intravenous drug use.
BACKGROUND
Necrotizing fasciitis (NF) is a relatively rare infection of soft tissues. This study reviewed the epidemiology and pathophysiology of admissions to a tertiary referral hospital over a twelve year period comparing outcomes and findings with international norms and to identify potential areas of change to optimise outcomes.


METHODS
A retrospective review of patients diagnosed with NF from Jan 1st 1999 to Dec 31st 2011 was performed. Patient demographics, risk factors, operative procedures, microbiology results and outcomes were recorded. Comparative analysis was performed.


RESULTS
37 patients were admitted with NF, comprising 30 males and 7 females with a median age of 55 years. The most common site of infection was the perineum (51%). The overall mortality rate was 29% and was significantly associated with age greater than 60 years (p = 0.0018) and the presence of one or more risk factor (p = 0.0046). The number of surgical procedures ranged from one to fifteen with a median length of stay of 35.5 days. There was a significant increase in the number of admissions in 2009-2010 (p < 0.001), coinciding with the emergence of NF in intravenous drug users (IVDU). 43% of patients (n = 16/37) required skin grafting, which was significantly higher in the IVDU group (n = 5/6, p = 0.0232).


CONCLUSIONS
Necrotizing fasciitis remains a significant life-threatening event. The diversity of causative pathogens emphasises the need for prompt microbiology/infectious diseases consultation. The increased occurrence within the IVDU cohort in this study highlights the need for a heightened level of clinical suspicion in these patients to prompt early surgical intervention.
Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.
Carmel
C
Waldron
Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland. Electronic address: gemmasolon@gmail.com.
Jacqueline Gemma
JG
Solon
Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin 2, Ireland; Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland.
Joanne
J
O'Gorman
Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin 2, Ireland; Department of Microbiology, Beaumont Hospital, Dublin 9, Ireland.
Hilary
H
Humphreys
Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.
John Patrick
JP
Burke
Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.
Deborah Ann
DA
McNamara
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000150:complications; D019115:Fasciitis, Necrotizing / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
Intravenous drug users; Necrotizing fasciitis; Outcomes