Patients with necrotizing fasciitis of extremities in ICU

Abstract

Study objective: To evaluate the relationship between the adequacies of effective empirical antimicrobial therapy for severe necrotizing fasciitis involve extremities and clinical outcome among patients required ICU admission. Design: Retrospective Study Setting: A medical and surgical ICU (18beds) from a government tertiary referral hospital Results: Between 1 Jan 2006 to 31 December 2010, 32 patients were admitted consecutively to intensive care unit and diagnosed suffering from necrotizing fasciitis of their extremities. . The mean age was 63 + 11.96 year old. Most patients had documented preexisting medical conditions(75%); the most common was diabetes mellitus in 12 patients (37.5%). 26 patients (81.25%) admitted to our unit for post operative care, while the rest were admitted for treatment of acute organs failure. A single causative organism was identified in 27 patients (84.4%). The most common organisms isolated were Streptococcus Pyogenes, Vibrio Vulnificus and Aeromonas species. 75% of patients suffered from Vibrio species and 50% of Aeromonas species associated necrotizing fasciitis had contact history with contaminated seawater/fresh water. Ten patients (31.25%) patients in this study received ineffective empirical antimicrobial therapy. The prolong duration between admissions to administration of effective antibiotic (hrs) associated with amputation of their extremities (15.79 + 17.30 hrs verses 4.93 +/-11.99 hrs; with P value = 0.005). Patients received amputation also had significantly lower hemoglobin level (9.03 gm/dl +1.72 versus 10.46gm/dl +1.77; P value = 0.036) and received less operations (2.0 +1.03 verses 3.25 +1.95; P value =0.026). ICU mortality was 37.5%. ICU nonsurvivors had statistically lower hemoglobin level, received less operation, and had higher APACHE II scores. The crude mortality rate was 43.75%. Pre existing diabetes mellitus, acute renal failure that required renal replacement therapy, high APACHE II scores were factors associated with increase in hospital mortality. Conclusion: Prompt diagnosis and early administration of effective antibiotic, reduced morbidity. Base on the bacteriologic findings, early use of board spectrum empirical antibiotics to cover Streptococcus, Enterobacteriaceae; Vibrio and Aeromonas species in patients with history of seafood and fresh/seawater contacted is recommended.