Necrotizing soft tissue infections of perianal and perineal region - still lethal infection

Abstract

Introduction/Objective. Necrotizing soft tissue infection is a life-threatening condition, characterized by widely spread necrosis of the skin, subcutaneous adipose tissue, fascia, and muscle. This study aimed to determine the risk factors associated with lethality due to necrotizing soft tissue infection of perianal and perineal region, for all patients surgically treated at a tertiary referral hospital. Methods. A retrospective review of 38 patients with necrotizing soft tissue infection of the perianal and perineal region, in the period between January 2007 and December 2014, was performed. We reviewed sex and age of the patients, the presence of known risk factors (diabetes mellitus, obesity, alcoholism), localization of necrotizing soft tissue infection, duration of symptoms, length of hospitalization, the number of necessary operations done, the performance of the stoma, and the outcome. We used logistic regression to identify the predictors of lethal outcome in a univariate analysis with estimated odds ratios and 95% confidence intervals. Results. There was a significantly higher fatality rate in the group of patients over 60 years of age (p < 0.05), with more than 10 days from the onset of symptoms to the treatment (p < 0.05), with a perianal localization (p < 0.05), and stoma creation (p < 0.05). The overall fatality rate was 18.4%. Conclusion. Patients’ age, time passed between the onset of the symptoms and the initiation of the treatment, perianal localization, and stoma creation were related to higher lethality risk.

Keywords

• necrotizing soft tissue infection
• necrotizing fasciitis
• Fournier's gangrene
• perianal region
• perineal region