title: Necrotising soft tissue infection in a UK metropolitan population.
abstract: BACKGROUND
  Necrotising soft tissue infection (NSTI) is a rare but life threatening diagnosis. Geographic, economic and social variances influence presentation and prognosis. As the current literature does not reflect a UK metropolitan population, we conducted a retrospective chart review to establish pertinent features relevant to our practice.
  
  
  METHODS
  Patients with histologically confirmed diagnoses of NSTI presenting to two London teaching hospitals between January 2007 and July 2013 were included in the study. Features of presentation, surgical and medical management, microbiological findings and outcome were evaluated.
  
  
  RESULTS
  Twenty-four patients with histologically confirmed NSTI were included. Two age clusters were identified, with means of 46 years (standard deviation [SD]: 10 years) and 80 years (SD: 6 years). Pain, erythema and sepsis were common findings. Hypertension, hypercholesterolaemia and type II diabetes mellitus were common co-morbidities. A third of younger patients had human immunodeficiency virus or hepatitis C, with a quarter dependent on drugs and/or alcohol. The mean Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score was 5.8 (SD: 3.3). The lower extremities, groin and perineum were common sites of infection. Fourteen patients required inotropic support and seventeen required transfusions. The median number of surgical procedures was 5 (range: 1-17). Group A Streptococcus was the most frequently identified pathogen. Five patients died. Being elderly, female sex and failure to use clindamycin as a first-line antibiotic were associated with significantly higher mortality.
  
  
  CONCLUSIONS
  In contrast to other recent series, group A streptococcal monomicrobial NSTI remains the most common presentation in our population. Survival is anticipated in young patients, regardless of premorbid status. Elderly patients have a poor prognosis. The negative predictive value of the LRINEC score is questioned. Use of clindamycin as a first-line antibiotic is supported.
authors.affiliation: Royal Free London NHS Foundation Trust, UK.
authors.forename: G E
authors.initials: GE
authors.lastname: Glass
authors.forename: F
authors.initials: F
authors.lastname: Sheil
authors.forename: J C
authors.initials: JC
authors.lastname: Ruston
authors.forename: P E M
authors.initials: PE
authors.lastname: Butler
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013290:Streptococcal Infections; D013297:Streptococcus pyogenes
chemical_list: D000900:Anti-Bacterial Agents