Understanding limb necrotizing infections: A comprehensive approach

A Garrido-Hidalgo; J García-Coiradas; M Echevarría-Marín; S Llanos; J A Valle-Cruz; F Marco

doi:10.1016/j.recot.2024.03.012

Understanding limb necrotizing infections: A comprehensive approach

Rev Esp Cir Ortop Traumatol. 2024 Apr 18:S1888-4415(24)00075-4. doi: 10.1016/j.recot.2024.03.012. Online ahead of print.

[Article in English, Spanish]

Authors

A Garrido-Hidalgo¹, J García-Coiradas², M Echevarría-Marín², S Llanos², J A Valle-Cruz², F Marco³

Affiliations

¹ Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Profesor Martín Lagos s/n Street, 28040 Madrid, Spain. Electronic address: anagh23@gmail.com.
² Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Profesor Martín Lagos s/n Street, 28040 Madrid, Spain.
³ Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Profesor Martín Lagos s/n Street, 28040 Madrid, Spain; Surgery Department, Complutense University, Madrid, Spain.

PMID: 38642737
DOI: 10.1016/j.recot.2024.03.012

Abstract

Introduction: Necrotizing soft tissue infections (NSTI) are increasing, posing a significant risk of morbidity and mortality. Due to nonspecific symptoms, a high index of suspicion is crucial. Treatment involves a multidisciplinary approach, with broad-spectrum antibiotics, early surgical debridement, and life support. This study analyzes the characteristics, demographics, complications, and treatment of NSTI in a hospital in Madrid, Spain.

Methods: A retrospective observational study was conducted, including all surgically treated NSTI patients at our center from January 2016 to December 2022, examining epidemiological and clinical data. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) was prospectively calculated for all patients.

Results: Twenty-two patients (16 men, 6 women, mean age 54.8) were included. Median time from symptom onset to emergency room visit was 3.5 days. All reported severe treatment-resistant pain; sixteen had fever exceeding 37.8°C (72.7%). Skin lesions occurred in twelve (54.5%), and thirteen had hypotension and tachycardia (59.1%). Treatment involved resuscitative support, antibiotherapy, and radical debridement. Median time to surgery was 8.25h. Intraoperative cultures were positive in twenty patients: twelve Streptococcus pyogenes, four Staphylococcus aureus, one Escherichia coli, and four polymicrobial infection. In-hospital mortality rate was 22.73%.

Conclusions: We examined the correlation between our results, amputation rates and mortality with LRINEC score and time to surgery. However, we found no significant relationship unlike some other studies. Nevertheless, a multidisciplinary approach with radical debridement and antibiotic therapy remains the treatment cornerstone. Our hospital stays, outcomes and mortality rates align with our literature review, confirming high morbimortality despite early and appropriate intervention.

Keywords: Debridement; Desbridamiento; Fasciitis; Fascitis; LRINEC; Necrotizante; Necrotizing; Piomiositis; Pyomyositis.