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Effect of comorbidities and impact of microbiological flora on management and outcome of necrotising fasciitis

Rohit Kumar Gohil, Rohit Chauhan, Devadatta Poddar.

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The study aims at assessing the effects of the most common comorbid condition, i.e. diabetes mellitus and the impact of the type of microbial flora on the management and outcome of necrotizing fasciitis.
Methods: This is a single-centre prospective observational study. A total of 135 patients with necrotising fasciitis from May 2011 to December 2013 were included in the study. Exclusion criteria were: patients with HIV and patients undergoing any treatment for malignancy. One hundred thirty-nine patients were enrolled, 4 excluded as they were found to be HIV positive. Repeated serial debridements were done. The study's endpoint was based on the four parameters- the appearance of healthy granulation tissue, no spread of wound margin, sterile pus culture report, and wound contraction. In addition, data were analyzed to see whether diabetes mellitus impacted the outcome and management of the necrotizing fasciitis and to find the association between microbiological flora and the course, severity and duration of the disease.
Results: The age ranged from 24 to 77 years, with a mean age of 47.62. Eighty-four (62.2%) patients with necrotizing fasciitis had a polymicrobial infection, and 51 (37.8%) were found to have a monomicrobial infection. The mean duration of hospitalisation for diabetic patients was 23.03 days (SD=5.47), and that of non-diabetic patients was 17.93 days (SD=4.46), which is statistically significant (P=0.004). The effect of microbial flora was substantial in the management of necrotising fasciitis. Conclusion: necrotizing fasciitis is a rapidly progressive and fatal infection. Every effort should be made to identify the association of diabetes and to classify the type of infection. Early aggressive debridement and intensive judicious antibiotics cover to decrease the chances of unfavourable outcomes.

Key words: necrotising fasciitis, wound debridement, diabetes mellitus, microbiological flora

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