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Postgraduate Thesis: A retrospective review of necrotizing fasciitis in a regional hospital in Hong Kong
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TitleA retrospective review of necrotizing fasciitis in a regional hospital in Hong Kong
 
AuthorsSinn, Ting-ting, Maria
冼婷婷
 
Issue Date2012
 
PublisherThe University of Hong Kong (Pokfulam, Hong Kong)
 
AbstractBackground Necrotizing fasciitis(NF) is a severe form of soft tissue infection that primarily involves the superficial fascia. The purpose of this study is, by reviewing all the NF cases in our hospital, to see if any areas that can be done to optimize the outcome of this group of patients. Objective To study the clinical features, risk factors, spectrum of organisms, treatment and outcomes of necrotizing fasciitis cases which were admitted to Tseung Kwan O Hospital. Methodology A retrospective study including 28 patients who were discharged with the diagnosis of ‘Necrotizing Fasciitis’ (NF) or ‘Fournier’s Gangrene’ (FG) in Tseung Kwan O Hospital from June 2010 to May 2012 were recruited. Data regarding co-morbidities, laboratory variables, micro-organisms and surgical treatment were collected. Fisher’s exact test and Mann-Witney U test were utilized for comparing variables. Results A total of 27 patients but 28 episodes were included in this study. The mean age of hospital survivors was 56.6 years(±17.9 years), while for the non-survivors was 60.6 years(±20.6 years). Diabetes mellitus (35.7%) and hypertension (46.4%) were the most frequent co-mobidities. Most (16, 57.1%) of them were in stage 1 NF, five (17.9%) in stage 2 and seven (25%) in stage 3. Less than half (39.3%) were febrile on admission. Fifty percent had one lower limb involvement on presentation, 32.1% had upper limb involvement and the rest (17.9%) were central NF, ie Fournier’s gangrene (FG), primarily involve the perineum on admission. Among the 23 NF cases, 39.1 % grew vibrio vulnificus, 21.7% grew streptococcus pyogenes ( in which one of them grew mixed streptococcus pyogenes and E.coli), 17.4% grew mixed flora. Among the 5 FG cases, all but one grew mixed flora. Of the 22 extremities NF cases who underwent operation, 10(45.5%) had amputation done. Mean number of operation was 4.1( range 1-16). The mean length of hospital stay for survivors were significantly longer than that of non-survivors (54.15 days [SD ± 49.66] vs 4.11 days[SD ± 4.11] , p <0.001). The overall hospital mortality was 32.1%. The presence of septic shock, disseminated intravascular coagulation and acute kidney injury were significantly associated with mortality. Conclusion Necrotizing fasciitis runs a rapid deteriorating course and is associated with high morbidity and mortality. The success in management requires prompt diagnosis, early and aggressive surgical debridement, as well as appropriate antibiotics.
 
DescriptionThesis (P. Dip.)--University of Hong Kong, 2012.
"This work is submitted to Faculty of Medicine of the University of Hong Kong in partial fulfillment of the requirements for the Postgraduate Diploma in Infectious Diseases, PDipID (HK)."
Includes bibliographical references.
 
DegreePostgraduate Diploma in Infectious Diseases
 
SubjectNecrotizing fasciitis -- China -- Hong Kong.
 
Dept/ProgramMicrobiology
 
DC FieldValue
dc.contributor.authorSinn, Ting-ting, Maria
 
dc.contributor.author冼婷婷
 
dc.date.accessioned2012-11-01T02:50:34Z
 
dc.date.available2012-11-01T02:50:34Z
 
dc.date.issued2012
 
dc.description.abstractBackground Necrotizing fasciitis(NF) is a severe form of soft tissue infection that primarily involves the superficial fascia. The purpose of this study is, by reviewing all the NF cases in our hospital, to see if any areas that can be done to optimize the outcome of this group of patients. Objective To study the clinical features, risk factors, spectrum of organisms, treatment and outcomes of necrotizing fasciitis cases which were admitted to Tseung Kwan O Hospital. Methodology A retrospective study including 28 patients who were discharged with the diagnosis of ‘Necrotizing Fasciitis’ (NF) or ‘Fournier’s Gangrene’ (FG) in Tseung Kwan O Hospital from June 2010 to May 2012 were recruited. Data regarding co-morbidities, laboratory variables, micro-organisms and surgical treatment were collected. Fisher’s exact test and Mann-Witney U test were utilized for comparing variables. Results A total of 27 patients but 28 episodes were included in this study. The mean age of hospital survivors was 56.6 years(±17.9 years), while for the non-survivors was 60.6 years(±20.6 years). Diabetes mellitus (35.7%) and hypertension (46.4%) were the most frequent co-mobidities. Most (16, 57.1%) of them were in stage 1 NF, five (17.9%) in stage 2 and seven (25%) in stage 3. Less than half (39.3%) were febrile on admission. Fifty percent had one lower limb involvement on presentation, 32.1% had upper limb involvement and the rest (17.9%) were central NF, ie Fournier’s gangrene (FG), primarily involve the perineum on admission. Among the 23 NF cases, 39.1 % grew vibrio vulnificus, 21.7% grew streptococcus pyogenes ( in which one of them grew mixed streptococcus pyogenes and E.coli), 17.4% grew mixed flora. Among the 5 FG cases, all but one grew mixed flora. Of the 22 extremities NF cases who underwent operation, 10(45.5%) had amputation done. Mean number of operation was 4.1( range 1-16). The mean length of hospital stay for survivors were significantly longer than that of non-survivors (54.15 days [SD ± 49.66] vs 4.11 days[SD ± 4.11] , p <0.001). The overall hospital mortality was 32.1%. The presence of septic shock, disseminated intravascular coagulation and acute kidney injury were significantly associated with mortality. Conclusion Necrotizing fasciitis runs a rapid deteriorating course and is associated with high morbidity and mortality. The success in management requires prompt diagnosis, early and aggressive surgical debridement, as well as appropriate antibiotics.
 
dc.description.naturepublished_or_final_version
 
dc.descriptionThesis (P. Dip.)--University of Hong Kong, 2012.
 
dc.description"This work is submitted to Faculty of Medicine of the University of Hong Kong in partial fulfillment of the requirements for the Postgraduate Diploma in Infectious Diseases, PDipID (HK)."
 
dc.descriptionIncludes bibliographical references.
 
dc.description.thesisdisciplineMicrobiology
 
dc.description.thesislevelPostgraduate diploma
 
dc.description.thesisnamePostgraduate Diploma in Infectious Diseases
 
dc.identifier.hkulb4832060
 
dc.identifier.urihttp://hdl.handle.net/10722/173742
 
dc.languageeng
 
dc.publisherThe University of Hong Kong (Pokfulam, Hong Kong)
 
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
 
dc.rightsThe author retains all proprietary rights, (such as patent rights) and the right to use in future works.
 
dc.subject.lcshNecrotizing fasciitis -- China -- Hong Kong.
 
dc.titleA retrospective review of necrotizing fasciitis in a regional hospital in Hong Kong
 
dc.typePG_Thesis
 
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<item><contributor.author>Sinn, Ting-ting, Maria</contributor.author>
<contributor.author>&#20924;&#23159;&#23159;</contributor.author>
<date.accessioned>2012-11-01T02:50:34Z</date.accessioned>
<date.available>2012-11-01T02:50:34Z</date.available>
<date.issued>2012</date.issued>
<identifier.uri>http://hdl.handle.net/10722/173742</identifier.uri>
<description>Thesis (P. Dip.)--University of Hong Kong, 2012.</description>
<description>&quot;This work is submitted to Faculty of Medicine of the University of Hong Kong in partial fulfillment of the requirements for the Postgraduate Diploma in Infectious Diseases, PDipID (HK).&quot;</description>
<description>Includes bibliographical references.</description>
<description.abstract>Background
Necrotizing fasciitis(NF) is a severe form of soft tissue infection that primarily
involves the superficial fascia. The purpose of this study is, by reviewing all the NF
cases in our hospital, to see if any areas that can be done to optimize the outcome of
this group of patients.
Objective
To study the clinical features, risk factors, spectrum of organisms, treatment and
outcomes of necrotizing fasciitis cases which were admitted to Tseung Kwan O
Hospital.
Methodology
A retrospective study including 28 patients who were discharged with the diagnosis of
&#8216;Necrotizing Fasciitis&#8217; (NF) or &#8216;Fournier&#8217;s Gangrene&#8217; (FG) in Tseung Kwan O
Hospital from June 2010 to May 2012 were recruited. Data regarding co-morbidities,
laboratory variables, micro-organisms and surgical treatment were collected. Fisher&#8217;s
exact test and Mann-Witney U test were utilized for comparing variables.
Results
A total of 27 patients but 28 episodes were included in this study. The mean age of
hospital survivors was 56.6 years(&#177;17.9 years), while for the non-survivors was 60.6
years(&#177;20.6 years). Diabetes mellitus (35.7%) and hypertension (46.4%) were the
most frequent co-mobidities. Most (16, 57.1%) of them were in stage 1 NF, five
(17.9%) in stage 2 and seven (25%) in stage 3. Less than half (39.3%) were febrile on
admission. Fifty percent had one lower limb involvement on presentation, 32.1% had
upper limb involvement and the rest (17.9%) were central NF, ie Fournier&#8217;s gangrene
(FG), primarily involve the perineum on admission. Among the 23 NF cases, 39.1 %
grew vibrio vulnificus, 21.7% grew streptococcus pyogenes ( in which one of them
grew mixed streptococcus pyogenes and E.coli), 17.4% grew mixed flora. Among the
5 FG cases, all but one grew mixed flora. Of the 22 extremities NF cases who
underwent operation, 10(45.5%) had amputation done. Mean number of operation was
4.1( range 1-16). The mean length of hospital stay for survivors were significantly
longer than that of non-survivors (54.15 days [SD &#177; 49.66] vs 4.11 days[SD &#177; 4.11] ,
p &lt;0.001). The overall hospital mortality was 32.1%. The presence of septic shock,
disseminated intravascular coagulation and acute kidney injury were significantly
associated with mortality.
Conclusion
Necrotizing fasciitis runs a rapid deteriorating course and is associated with high
morbidity and mortality. The success in management requires prompt diagnosis, early
and aggressive surgical debridement, as well as appropriate antibiotics.</description.abstract>
<language>eng</language>
<publisher>The University of Hong Kong (Pokfulam, Hong Kong)</publisher>
<rights>Creative Commons: Attribution 3.0 Hong Kong License</rights>
<rights>The author retains all proprietary rights, (such as patent rights) and the right to use in future works.</rights>
<subject.lcsh>Necrotizing fasciitis -- China -- Hong Kong.</subject.lcsh>
<title>A retrospective review of necrotizing fasciitis in a regional hospital in Hong Kong</title>
<type>PG_Thesis</type>
<identifier.hkul>b4832060</identifier.hkul>
<description.thesisname>Postgraduate Diploma in Infectious Diseases</description.thesisname>
<description.thesislevel>Postgraduate diploma</description.thesislevel>
<description.thesisdiscipline>Microbiology</description.thesisdiscipline>
<description.nature>published_or_final_version</description.nature>
<bitstream.url>http://hub.hku.hk/bitstream/10722/173742/1/FullText.pdf</bitstream.url>
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