Clinico-Microbiological Aspects of Necrotizing Fasciitis in Type II Diabetes Mellitus

• Published in: Indian journal of surgery 2011-06, Vol.73 (3), p.178
• Main Authors: Bosco Chandra Kumar, Asayas, Subramanyam, S G, Kilpadi, Arun B
• Format: Article
• Language: English
• Subjects: Antibiotics; Bacteria; Diabetes; Medical diagnosis; Necrotizing fasciitis; Surgery
• ISSN: 0972-2068; 0973-9793
• DOI: 10.1007/s12262-010-0116-2

Necrotizing fasciitis is insidiously advancing soft tissue infection, characterized by widespread fascial necrosis. One of the most common conditions encountered in the clinical practice and which required clinical suspicion in patients who have less resistance to these infections. Especially in diabetic patients who are more prone for such infection due to low immunity and other reasons like early detection of these infections helps these patients to have a better recovery by aggressive surgical management and other measures required for the same. Literature has enough evidence on how serious this entity. Hence this study is designed in that aspect to help in early diagnosis and appropriate treatment. This study will help to determine the clinical presentation, the polymicrobial involved. The organisms most closely linked to necrotizing fasciitis are group A beta-hemolytic streptococci, although the disease may also be caused by other bacteria and their sensitivity patterns will help us to install appropriate antibiotics with the surgical management. And to compare our mortality rate with the other studies. A prospective descriptive study including all type II diabetic patients with necrotizing fasciitis over 3 years. Patients were evaluated in detail with respect to patient's history, examination, culture sensitivity and chart reviews and followed up using standard evaluation tools to measure the various outcomes. In 62 patients, the commonest clinical presentation was necrotic patch of skin and cellulites. The organisms cultured being beta hemolytic streptococci and E.Coli. The culture sensitivity pattern is to broad-spectrum antibiotics. The average stay in the hospital was about 13.74 days for the study group and the time delay in presentation is 6 days. Wagner's score is a useful tool for aiding the diagnosis. Patients without foot care had extensive lesions. And a mortality rate of 1.6 % in these patients. In an acutely swollen limb in a diabetic patient a high degree of suspicion of necrotizing fasciitis is required. A detailed foot care is warranted in these patients. An early extensive debridement is mandatory and key for a favorable outcome. And to start on broad- spectrum antibiotics is advisable. Wagner's scoring is helpful to predict the chances of a second surgery. With the above entities in mind the mortality rate of necrotizing fasciitis in type ii diabetes mellitus can be contained.[PUBLICATION ABSTRACT]