THE CLINICAL SPECTRUM OF NECROTIZING FASCIITIS - A REVIEW OF 15 CASES

Background: Necrotising fasciitis represents a spectrum of disease whi ch ranges from fulminant through acute to subacute varieties. While fu lminating necrotising fasciitis is a well recognised entity the subacu te variety is not. Aim: To assess six years' experience of necrotising fasciitis at Waikato Hospital. Method: Cases of necrotising fasciitis were identified from discharge statistics for the period 1990-1995. R ecords were reviewed for clinical features, predisposing factors, micr obiology, histology, treatment and outcome. Results: Fifteen cases wer e identified of which ten were female. The average age was 55 years (r ange of 15-92 years). One patient presented with fulminant, eight with acute and six with subacute necrotising fasciitis. Significant bliste r formation was noted in eight cases. Risk factors were identified in 14 patients including trauma, renal impairment, diabetes mellitus, and various drugs including diclofenac (four patients), naproxen (one pat ient) and prednisone (two patients). Group A beta haemolytic streptoco ccus (GABHS) was identified in ten cases. Swab or tissue cultures had the highest yield for isolating the organism. Blood cultures grew GABH S in only three of 12 cases. Eight patients (53%) died. Of the survivo rs all but one patient required debridement and skin grafting. Conclus ions: Necrotising fasciitis is a clinical spectrum of disease. It affe cts a wide age group and can have associated morbidities. It is often a fatal disease. Early recognition, high dose antibiotics and surgical debridement are important in the management of the entire spectrum of necrotising fasciitis.