From the Guidelines
Necrotizing fasciitis has a mortality rate ranging from 7.5% to 88% depending on the population and severity of the disease, with prompt recognition and treatment being crucial for survival. The mortality rate can be as high as 88% in some studies, but a more recent study by Sorensen and colleagues reported a mortality rate of 7.5% 1. Factors that worsen prognosis include advanced age, immunocompromised status, diabetes, obesity, and involvement of the trunk or perineum rather than extremities.
Key Factors Influencing Mortality
- Advanced age
- Immunocompromised status
- Diabetes
- Obesity
- Involvement of the trunk or perineum rather than extremities
Importance of Prompt Treatment
Prompt recognition and treatment are of utmost importance in reducing mortality rates. Delays in surgical debridement can significantly increase the risk of death, with each hour of delay associated with increased mortality risk.
Treatment Approach
Treatment must include immediate surgical debridement of all necrotic tissue, broad-spectrum antibiotics, and intensive supportive care. The use of scoring systems such as the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score and the Fournier’s Gangrene Severity Index (FGSI) can help in guiding correct management and predicting patient mortality 1.
Antibiotic Therapy
Broad-spectrum antibiotics, such as combinations including piperacillin-tazobactam, meropenem, vancomycin, and clindamycin, are recommended for the treatment of necrotizing fasciitis 1. The choice of antibiotics should be guided by the suspected or confirmed pathogens and their susceptibility patterns.
Adjunctive Treatments
Hyperbaric oxygen therapy and intravenous immunoglobulin may be considered as adjunctive treatments in certain cases, though their impact on mortality remains debated.
Overall, the key to reducing mortality from necrotizing fasciitis is prompt recognition and aggressive treatment, including surgical debridement and broad-spectrum antibiotics.
From the Research
Mortality Rate of Necrotizing Fasciitis
- The mortality rate of necrotizing fasciitis is reported to be around 12.6% 2, 26.6% 3, and 15% 4 in different studies.
- Factors associated with a higher mortality risk include older age, chronic liver diseases, disseminated intravascular coagulopathy, septic shock, pulmonary complications, acute renal failure, and not undergoing surgical intervention 2.
- Diabetes mellitus is a common predisposing factor, but mortality in patients with diabetes was substantially lower (8.5% vs. 16.5%) 2.
- The most common presentation is septicemia, and lack of surgical intervention is associated with a higher mortality 2.
Factors Associated with Mortality
- Demographic factors associated with in-hospital mortality include older age, coronary artery disease, chronic kidney disease, and transfer from an outside hospital 4.
- Clinical characteristics associated with in-hospital mortality include positive initial blood culture results, lactic acidosis, and multiple organ dysfunction syndrome 4.
- Laboratory values at initial presentation that are associated with in-hospital mortality include platelet count, serum pH, serum lactate, serum creatinine, partial thromboplastin time, and international normalized ratio 4.
Treatment and Management
- Prompt diagnosis and proper medical and surgical management of necrotizing fasciitis can improve outcomes 5.
- Treatment involves repeated surgical debridement of necrotic tissues in addition to intravenous antibiotics 5.
- Adjuvant therapies with intravenous immunoglobulin and hyperbaric oxygen therapy might have a role in reducing mortality 2, 3.
- Early diagnosis, combined with surgical debridement and probabilistic antibiotic therapy, are required to increase the survival rate 6.