FLESH EATING DISEASE: A 15-YEAR REVIEW OF NECROTISING SOFT TISSUE INFECTIONS IN SOUTH AUSTRALIA

Abstract

Intro: Necrotising soft tissue infection (NSTI) is associated with high mortality and morbidity. Factors shown to reduce mortality and morbidity include early disease recognition, appropriate antibiotic therapy and prompt surgical intervention. Studies examining epidemiology and management of NSTI globally are sparse due to a lack of centralised database. Methods: This retrospective study was conducted by accessing electronic medical records at a single large health network (Central Adelaide Local Health Network, Adelaide South Australia). Pertinent information relating to patient factors, microbiological data and clinical outcomes were collected. Findings: A total of 167 cases of NSTI were identified with an overall mortality of 12%. Median length of hospitalization was 22 days. Overall, 149 patients (80.2%) underwent early surgery with a mortality of 10% compared to 28% of those had delayed surgery irrespective of antibiotic choice (p=0.03). The majority of NSTI (86.8%) involved a single anatomical site. Most infections were polymicrobial (55%) with nearly half of these infections involving the perineal or perianal region (46%). Monomicrobial infections accounted for 38% of NSTIs, of which S. pyogenes and S. aureus were the two most common pathogens isolated. Appropriate empiric antibiotic treatment was used in 59% of NSTI patients. Discussion: NSTI related mortality is reducible by up to 50% with broad- spectrum antibiotics and early surgery. Within our cohort, NSTI remains a condition with high morbidity demonstrated by a median length of hospitalization exceeding three weeks and a mortality up to 12%. From our study, treatment at a minimum either with broad-spectrum antimicrobials or early surgical intervention may be protective but utilizing both shows the highest mortality benefit and should remain standard of care. Conclusion: NSTIs are associated with significant morbidity and mortality, though improved through early surgical intervention in combination with broad spectrum antimicrobial therapy.