Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 10 , ISSUE 4 ( October, 2006 ) > List of Articles


Necrotizing fasciitis: A decade of surgical intensive care experience

Nissar Shaikh

Keywords : Foot, leg, necrotizing fasciitis, streptococci, type 1

Citation Information : Shaikh N. Necrotizing fasciitis: A decade of surgical intensive care experience. Indian J Crit Care Med 2006; 10 (4):225-229.

DOI: 10.4103/0972-5229.29840

License: CC BY-ND 3.0

Published Online: 01-10-2010

Copyright Statement:  Copyright © 2006; The Author(s).


Necrotizing fasciitis is a rare disease, potentially limb and life-threatening infection of fascia, subcutaneous tissue with occasionally muscular involvement. Necrotizing faciitis is a surgical emergency with high morbidity and mortality. Aim: Aim of this study was to analyze presentation, microbiology, surgical, resuscitative management and outcome of this devastating soft tissue infection. Materials and Methods: The medical records of necrotizing fasciitis patients treated in surgical intensive care unit (SICU) of our hospital from Jan 1995 to Feb 2005 were reviewed retrospectively. Results: Ninety-four patients with necrotizing fasciitis were treated in the surgical intensive care unit during the review period. Necrotizing fasciitis accounted for 1.15% of total admissions to our SICU. The mean age of our patients was 48.6 years, 75.5% of the cases were male. Diabetes mellitus was the most common comorbid disease (56.4%), 24.5% patients had hypertension, 14.9% patients had coronary artery disease, 9.6% had renal disease and 6.4% cases were obese. History of operation (11.7%) was most common predisposing factor in our patients. All patients had leucocytosis at admission to the hospital. Mean duration of symptoms was 3.4 days. Mean number of surgical debridement was 2.1, mean sequential organ failure assessment (SOFA) score at admission to SICU was 8.6, 56.38% cases were type 1 necrotizing fasciitis and 43.61% had type 2 infection. Streptococci were most common bacteria isolated (52.1%), commonest regions of the body affected by necrotizing fasciitis were the leg and the foot. Mean intubated days and intensive care unit (ICU) stay were 4.8 and 7.6 days respectively. Mean fluid, blood, fresh frozen plasma and platelets concentrate received in first 24 hours were 4.8 liters, 2.0 units, 3.9 units and 1.6 units respectively. Most commonly used antibiotics were piperacillin with tazobactum and clindamycin. Common complication was ventricular tachycardia (6.4). 46.8% patients had multi organ dysfunction, 15 of them died giving a mortality of 16% in this study. Conclusion: Necrotizing fasciitis is more common in males, diabetes mellitus was the most common comorbid disease, type 1-necrotizing fasciitis was more common and the most common regions of the body affected by necrotizing fasciitis were the leg and the foot.

PDF Share
  1. Decamps V, Atiken J, Lee MG. Hippocrates on necrotizing fasciitis. Lancet 1994;344:556.
  2. Wilson B. Necrotizing fasciitis. Am Surg 1952;18:416-31.
  3. Bilton BD, Zibari GB, McMillan RW, Aultman DF, Dunn G, McDonald JC. Aggressive surgical management of necrotizing fasciitis serve to decrease mortality: A retrospective study. Am Surg 1998;64:397-401.
  4. Helmy AS, Salah MA, Nawara HA, Khatab H, Khalaf HA, Abd el-Maguid N. Life threatening cervical necrotizing fasciitis. J R Coll Surg Edinb 1997;64:410-3.
  5. Mchenny CR, Piotrowski JJ, Pertrinic D, Malagani MA. Determinants of mortality in necrotizing soft tissue infections. Ann Surg 1995;221:558-65.
  6. Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: Clinical presentation, microbiology and determinant of mortality. J Bone Joint Surg 2003;85:1454-60.
  7. Veenstra RP, Manson WE, van der Werf TS, Fijen JW, Tulleken JE, Zijlstra JG, et al. Fulminant necrotizing fasciitis and nonsteriodal anti inflammatory drugs. Intensive Care Med 2001;27:1831.
  8. Singh G, Sinha SK, Adhikary S, Babu KS, Ray P, Khanna SK. Necrotizing infection of the soft tissue: A clinical profiles. Eur J Surg 2002;168:366-71.
  9. Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg 1996;224:672-83.
  10. Wilkerson R, Paull W, Coville FV. Necrotizing fasciitis: A case report and review of literature. Clin Orth Rel Res 1987;216:187-92.
  11. Hasham S, Matteucci P, Stanley PR, Hart NB. Necrotizing fasciitis. Br Med J 2005;330:830-3.
  12. McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinant of mortality in necrotizing soft tissue infections. Ann Surg 1995;221:558-65.
  13. Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (laboratory risk indicators for necrotizing fasciitis) score: A tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004;32:1535-41.
  14. Drake DB, Woods JA, Bill TJ, Kesser BW, Wenger MA, Neal JG, et al. Magnetic resonance imaging in early diagnosis of necrotizing fasciitis. J Emerg Med 1997;16:403-7.
  15. Seal DV. Necrotizing fasciitis. Curr Opin Infect Dis 2001;14:127-32.
  16. Andresen T, Green SD, Childers BJ. Massive soft tissue injury: Diagnosis and management of necrotizing fasciitis and purpura fulminans. Plast Reconstr Surg 2001;107:1025-35.
  17. Lewis RT. Necrotizing soft tissue infections. Infect Dis Clin North Am 1992;6:693-700.
  18. Urschel JD. Necrotizing soft tissue infections. Postgrad Med J 1999;75:645-9.
  19. Elliott D, Kufera JA, Myers RA. The microbiology of necrotizing soft tissue infections. Am J Surg 2000;179:61-6.
  20. Brook I, Frazier EH. Clinical and microbiological features of necrotizing fasciitis. J Clin Microbial 1995;33:2582-7.
  21. Kaul R, McGeer A, Low DE, Green K, Schwartz B. Population-based surveillance for group A streptococcal necrotizing fasciitis: Clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Ontario Group A Streptococcal Study. Am J Med 1997;103:18-24.
  22. Yen JC, Feng Z. Salvage of limb and function in necrotizing fasciitis of the hand: Role of hyperbaric oxygen treatment and free muscle flap coverage. South Med J 2002;95:255-7.
  23. Zimbelman J, Palmer A, Todd J. Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes infection. Pediatr Infec Dis Jr 1999;18:1096-100.
  24. Bakleh M, Wold LE, Mandrekar JN, Harmsen WS, Dimashkieh HH, Baddour LM. Correlation of histopathological findings with clinical outcome in necrotizing Fasciitis. Clin Infect Dis 2005;40:410-4
  25. Maheboob SN, Louon AM, Ahmed AH. Necrotizing fasciitis complicated by multiple pneumoceles. Saudi Med J 2003;24:12:1394-6.
  26. Hscich WS, Yang PH, Chao HC. Necrotizing fasciitis: A case report of three cases and review of literature. Pediatrics 1999;103:53.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.