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Mekkodathil A, El-Menyar A, Natesa Mudali I, Al-Sulaiti M, Shaikh N, Al-Thani H. Temporal and seasonal trends of hospitalization and mortality associated with necrotizing fasciitis: A retrospective study of 12 years (2002-2013). Qatar Med J 2020; 2020:37. [PMID: 33425693 PMCID: PMC7759011 DOI: 10.5339/qmj.2020.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/27/2020] [Indexed: 11/03/2022] Open
Abstract
Background: Necrotizing fasciitis (NF) is a rare but aggressive infection that affects the superficial fascia and progressively destroys the tissue between the skin and underlying muscles. It is a surgical emergency with significant morbidity and mortality. This study aimed to explore the temporal and seasonal trends in NF infection in Qatar. Methods: A total of 327 patients diagnosed with NF, aged ≥ 18 years, and admitted to the Hamad General Hospital, Qatar, in 2002-2013 were retrospectively reviewed. The hospitalization and mortality rates in the general population in Qatar and the case fatality rate (CFR) were calculated for each year. The patients were grouped into summer, autumn, winter, and spring admissions based on their admission dates. Seasonality was studied by comparing the characteristics, bacteriological status, and outcomes of the patients admitted in different seasons. Results: The hospitalization rate of NF in Qatar was 2.9 per 100,000 population; in the study duration, this rate decreased from 2.8 to 1.6 per 100,000 population in 2002 and 2013, respectively. The mortality rate among NF cases increased from 1.9 to 3.6 per million population, and the CFR increased from 6.7 to 23 per 100 admissions in the same duration. No temporal trends in the hospitalization and mortality rates or CFR were evident in the study duration. Polybacterial infections were higher in autumn than in other seasons. Monobacterial Gram-positive infections were higher in spring than in other seasons, and monobacterial Gram-negative infections were higher in summer than in other seasons (p = 0.02). However, seasonality was not evident after further analysis in terms of species, severity, complications, length of hospital stays, and CFR in patients with NF. Conclusion: No clear trend or seasonality was observed in terms of outcomes; however, seasonality in NF-causing bacteria was evident, as polybacterial infections were significantly higher in autumn than in other seasons, whereas monobacterial infections were more frequent in spring and summer than in other seasons. However, the severity of infections, length of hospital stay, and mortality did not significantly vary. Further microbiological studies are needed to obtain confirmatory data regarding the temporal and seasonal trends of NF.
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Affiliation(s)
- Ahammed Mekkodathil
- Clinical Research, Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | | | | | | | - Nissar Shaikh
- Department of Anesthesia & ICU, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, Hamad General Hospital
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Jabbour G, El-Menyar A, Peralta R, Shaikh N, Abdelrahman H, Mudali IN, Ellabib M, Al-Thani H. Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital. World J Emerg Surg 2016; 11:40. [PMID: 27508002 PMCID: PMC4977757 DOI: 10.1186/s13017-016-0097-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/02/2016] [Indexed: 12/18/2022] Open
Abstract
Background Necrotizing fasciitis (NF) is a fatal aggressive infectious disease. We aimed to assess the major contributing factors of mortality in NF patients. Methods A retrospective study was conducted at a single surgical intensive care unit between 2000 and 2013. Patients were categorized into 2 groups based on their in-hospital outcome (survivors versus non-survivors). Results During a14-year period, 331 NF patients were admitted with a mean age of 50.8 ± 15.4 years and 74 % of them were males Non-survivors (26 %) were 14.5 years older (p = 0.001) and had lower frequency of pain (p = 0.01) and fever (p = 0.001) than survivors (74 %) at hospital presentation. Diabetes mellitus, hypertension, and coronary artery disease were more prevalent among non-survivors (p = 0.001). The 2 groups were comparable for the site of infection; except for sacral region that was more involved in non-survivors (p = 0.005). On admission, non-survivors had lower hemoglobin levels (p = 0.001), platelet count (p = 0.02), blood glucose levels (p = 0.07) and had higher serum creatinine (p = 0.001). Non-survivors had greater median LRINEC (Laboratory Risk Indicator for NECrotizing fasciitis score) and Sequential Organ Failure Assessment (SOFA) scores (p = 0.001). Polybacterial and monobacterial gram negative infections were more evident in non-survivors group. Monobacterial pseudomonas (p = 0.01) and proteus infections (p = 0.005) were reported more among non-survivors. The overall mortality was 26 % and the major causes of death were bacteremia, septic shock and multiorgan failure. Multivariate analysis showed that age and SOFA score were independent predictors of mortality in the entire study population. Conclusion The mortality rate is quite high as one quarter of NF patients died during hospitalization. The present study highlights the clinical and laboratory characteristics and predictors of mortality in NF patients.
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Affiliation(s)
- Gaby Jabbour
- Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Ruben Peralta
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
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Shaikh N, El-Menyar A, Mudali IN, Tabeb A, Al-Thani H. Clinical presentations and outcomes of necrotizing fasciitis in males and females over a 13-year period. Ann Med Surg (Lond) 2015; 4:355-60. [PMID: 26568823 PMCID: PMC4602355 DOI: 10.1016/j.amsu.2015.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 07/29/2015] [Accepted: 09/11/2015] [Indexed: 12/20/2022] Open
Abstract
Background Necrotizing fasciitis (NF) is a rapidly progressive infection of fascia and subcutaneous tissue resulting in serious outcomes. We aimed to evaluate the clinical presentations, hospital course and outcomes of NF based on patient gender. Patients and methods All patients admitted with NF were enrolled in the study over a 13-year period in the main tertiary hospital in Qatar. Clinical presentations, co-morbidities, severity and outcomes were analyzed and compared in male and female patients. Results A total of 331 NF patients were identified with a mean age of 51 ± 15 years and male to female ratio of 3:1. However, Arab Qatari females were more frequently affected by NF in comparison to their male counterparts and south Asian females (p < 0.001), respectively. Female patients were older and had significantly higher incidence of abdominal and groin NF (p < 0.004). There were 13 cases with recurrent NF; 85% of them were males. Male NF patients had significantly higher rate of organ failure (p = 0.02), but there was no significant difference in the hospital length of stay as well as mortality in both genders. Overall, there were 85 (25.7%) deaths (23 females and 62 males). Conclusion Necrotizing fasciitis remains a life threatening entity. Although, NF is more common in males, Qatari females are more likely to develop NF than males. NF of abdominal wall and groin is significantly higher in females. Development of organ failure is more common in males with NF. NF remains a challenging clinical problem in Qatar with a mortality rate ranging from 25 to 27% for both genders. Majority of Necrotizing Fasciitis (NF) patients are males (74%). NF of abdomen and groin is significantly higher in females. Male patients are more severely ill with significantly more organ dysfunction. Hospital stay and mortality of NF in both genders are comparable. NF remains a challenging clinical problem in Qatar with a mortality rate ranging from 25 to 27% for both genders.
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Affiliation(s)
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery, HGH, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | | | - AbdelHakem Tabeb
- Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery, HGH, Doha, Qatar ; Department of Surgery, Hamad General Hospital (HGH), Doha, Qatar
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Al-Thani H, El-Menyar A, Shaikh N, Mudali IN, Mekkodathil A, Asim M, Gameil A, Tabeb A. Risk Stratification of Necrotizing Fasciitis Based on the Initial Procalcitonin Concentration: A Single Center Observational Study. Surg Infect (Larchmt) 2015; 16:806-12. [PMID: 26280767 DOI: 10.1089/sur.2014.249] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a potentially fatal subcutaneous tissue and fascia infection. We studied the role of serum procalcitonin in the identification and assessment of severity of sepsis in patients with NF. METHODS A retrospective analysis was conducted from January 2000 to December 2013 for all patients who admitted to surgical intensive care with provisional diagnosis of NF. Patients were categorized into four groups based on the initial procalcitonin concentrations (Group I: <0.5 low risk, Group II: ≥0.5-<2 moderate risk, Group III: ≥2-<10 high risk, and Group IV: ≥10 ng/mL high likelihood of severe sepsis). RESULTS During the study period, 331 cases were identified to have NF with a mean age of 51 ± 14 years. Serum procalcitonin was tested in 62 cases (only between 2011 and December 2013) and all were positive (Group I: 22%, Group II: 18%, Group III: 21%, and Group IV: 39%). The most common affected regions were thigh and chest in Group II (46% and 9%, respectively), lower limbs in Group III (46%), and perineum and abdomen in Group IV (25% and 21%, respectively). In the four groups, 21 patients developed septic shock (Group I: 0%, Group II: 14%, Group III: 24%, and Group IV: 62%). The cut off procalcitonin value for septic shock was 5.6 ng/mL. Using receiver-operating characteristic curve, this cut off with the Area under the Curve (AUC) of 0.77 was found to have sensitivity 81% and specificity 67%. Sequential Organ Failure Assessment (SOFA) score was substantially greater in Group III and Group IV in comparison to Group I and Group II, p = 0.006. Procalcitonin levels were correlated well with SOFA score (r = 0.34, p = 0.007). There were 17 deaths in the four groups (Group I: 6%, Group II: 23%, Group III: 12%, and Group IV: 59%). CONCLUSION Initial procalcitonin concentration in NF carries an important prognostic value and it correlates well with SOFA score and can predict the development of septic shock early in patients with NF.
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Affiliation(s)
- Hassan Al-Thani
- 1 Department of Surgery, Hamad General Hospital , Doha, Qatar
| | - Ayman El-Menyar
- 2 Department of Clinical Research, Trauma Surgery, Hamad General Hospital , Doha, Qatar .,3 Department of Clinical Medicine, Weill Cornell Medical School , Doha, Qatar
| | - Nissar Shaikh
- 4 Surgical Intensive Care Unit, Hamad General Hospital , Doha, Qatar
| | | | - Ahammed Mekkodathil
- 2 Department of Clinical Research, Trauma Surgery, Hamad General Hospital , Doha, Qatar
| | - Mohammad Asim
- 2 Department of Clinical Research, Trauma Surgery, Hamad General Hospital , Doha, Qatar
| | - Amna Gameil
- 1 Department of Surgery, Hamad General Hospital , Doha, Qatar
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Faraj JH, Vegesna ARR, Mudali IN, Khairay MA, Nissar S, Alfarhan M, Sabir K, El-Imam F, Anto L, Go T. Survey and management of anaesthesia related complications in PACU. Qatar Med J 2012; 2012:64-70. [PMID: 25003043 PMCID: PMC3991034 DOI: 10.5339/qmj.2012.2.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 12/01/2012] [Indexed: 11/17/2022] Open
Abstract
It is the first prospective study about anaesthesia related postoperative complications conducted in Hamad General Hospital. Total 1128 adult patients admitted to the Post Anaesthesia Care Unit (PACU) during a period of three months were surveyed for anaesthesia related complications. Documented complications were found in 48 patients i.e. 4.25% of patients' population. The types of complications were related to the respiratory system, cardiovascular system, nausea/vomiting and body temperature in this descending order. Most of the complications happened to healthy ASA I and II patients. Factors that play major role in determining the immediate postoperative complications were the ASA status, the level of anaesthesia seniority attending the patient, the urgency and the nature of procedure. We tried to find other factors that may influence complications in addition, discussed below.
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Affiliation(s)
- Jafar H Faraj
- Consultant Anaesthesia/ICU, Hamad General Hospital, Doha, Qatar
| | - A R R Vegesna
- Consultant Anaesthesia/ICU, Hamad General Hospital, Doha, Qatar
| | - I N Mudali
- Specialist, Anaesthesia/ICU, Hamad General Hospital, Doha, Qatar
| | - M A Khairay
- Specialist, General Surgery, Hamad General Hospital, Doha, Qatar
| | - Shaikh Nissar
- Consultant Anaesthesia/ICU, Hamad General Hospital, Doha, Qatar
| | - Muna Alfarhan
- Director of Nursing, HGH-OR, OR-PACU and Day Surgery, Hamad General Hospital, Doha, Qatar
| | - Kareema Sabir
- Registered Nurse, Head of PACU, Hamad General Hospital, Doha, Qatar
| | - Fawkia El-Imam
- Registered PACU Nurses, Hamad General Hospital, Doha, Qatar
| | - Lucy Anto
- Registered PACU Nurses, Hamad General Hospital, Doha, Qatar
| | - Teofila Go
- Registered PACU Nurses, Hamad General Hospital, Doha, Qatar
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