Severe necrotising soft tissue infections in orthopaedic surgery

Integrated clinical care pathway for managing necrotising soft tissue infections

BACKGROUND

Necrotising soft tissue infections (NSTI) are relatively common infections with high morbidity and mortality rate, as they often present late in their course. Quick and aggressive surgical treatment improves survival and decreases hospital stay.

MATERIALS AND METHODS

All patients with NSTI managed at our centre from June 2007 to January 2009 were included in this prospective study. We evaluated various parameters like age, co-morbidities, biochemical parameters, time interval between admission and first operative intervention, against duration of hospital stay and out come of the case.

RESULTS

Fifty-four patients with NSTI were admitted and treated during the study period. Male to female ratio was 6:1. Mean time interval between admission and operative intervention was 6 hours. Mean period of hospitalisation was 53 days and we had limb salvage rate of 100% and one mortality (1.85%). Diabetes mellitus was the most common co-morbid condition and Staphylococcus aureus the most common isolate. Presence of leucocytosis, hyponatraemia, hypoalbuminaemia, anaemia and deranged renal functions were found to be poor prognostic factors.

CONCLUSION

Late and varied presentation is the rule rather than exception with NSTI. Early recognition of the condition, with emergency operative intervention and repeated debridement by a dedicated surgical team, is the key to patient survival and limb salvage.

Skin and soft tissue infections

Skin and soft tissue infections are a common cause of hospitalization and use of antibiotic therapy, and may result in significant disability. Infections managed by surgeons may vary from simple, noncomplicated cellulitis to severe necrotizing soft tissue infections. The differentiation of necrotizing infections from nonnecrotizing infections is critical to achieving adequate surgical therapy. An understanding of the changing epidemiology of all complicated skin and soft tissue infections is required for selection of appropriate empiric antibiotic therapy.