Clinical and Microbiological Spectrum of Necrotizing Fasciitis in Surgical Patients at a Philippine University Medical Centre

Objective: The study describes the clinical characteristics, bacteriology and risk factors for mortality of patients with necrotizing fasciitis (NF), seen in a university medical centre.

Methods: The medical charts of NF patients admitted to the institution from January 2004 to July 2007 were retrieved and reviewed retrospectively.

Results: The majority of the 67 patients included in the study presented with localized nonspecific inflammatory manifestations: tenderness (94%), warmth (86%), oedema (76%), skin necrosis (75%), and ulceration (68%). Diabetes mellitus (22%) was the most common predisposing medical condition. The most frequent isolates were Escherichia coli (44%), Acinetobacter baumannii (19%), Staphylococcus aureus (15%) and Enterococcus faecium (15%). Overall mortality rate was 36%. Risk factors significantly associated with mortality were truncal involvement (p = 0.034), leukocytosis (p = 0.038), acidosis (p = 0.001), hypoalbuminaemia (p = 0.004), hypocalcaemia (p = 0.000) and hyponatraemia (p = 0.023). Logistic regression analysis revealed acidosis [p < 0.05, odds ratio (OR) = 9] and hypoalbuminaemia (p < 0.05, OR = 14) as significant independent risk factors for mortality.

Conclusion: The identified risk factors can inform clinicians of increased mortality risks for certain patients with NF. They should serve as a trigger for more aggressive surgical and critical care, and antimicrobial therapy for these patients.