Kariksiz Mesut, Ates Okan
Department of Orthopedic and Traumatology, Basaksehir Cam and Sakura City Hospital, University of Health Sciences, Istanbul, Turkey.
Department of Orthopedic and Traumatology, Gazi Yasargil Training and Research Hospital, University of Health Sciences, Diyarbakir, Turkey.
Eur J Trauma Emerg Surg. 2025 Mar 24;51(1):148. doi: 10.1007/s00068-025-02835-5.
Necrotizing soft tissue infection (NSTI) is a rapidly progressing infection of the soft tissues under the skin, which poses a life-threatening risk if not treated promptly. Due to the non-specific nature of symptoms at presentation, the diagnosis is often delayed, leading to a high mortality rate and increased risk of amputation. Early treatment requires both surgical intervention and antibiotic therapy. This study aims to investigate the effects of clinical parameters, applied treatments, and initial interventions on mortality and amputation rates in patients with NSTI.
In a retrospective study, 50 patients diagnosed with NSTI between 2021 and 2024 were included. Patient demographic characteristics (age, gender, comorbidities), isolated microorganisms, antibiotics administered, interventions performed, and the final outcomes were analyzed. Additionally, the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, duration of intensive care unit (ICU) stay, length of hospital stay, rates of mortality and amputation were examined.
Among the 50 patients in this study, the mortality rate due to NSTI was 20% (10 patients), and the amputation rate was 60% (30 patients). Both the length of hospital stay and duration of ICU stay were significantly associated with mortality. Diabetes mellitus (DM) was found to be significantly related to amputation. The LRINEC score, presence of chronic renal failure, sepsis, hyperbaric oxygen therapy (HBOT), smoking, and timing of surgical intervention were not significantly associated with amputation rates. The most common isolated microorganism was Streptococcus pyogenes.
Although the LRINEC score is widely used, it does not play a critical role in the management of NSTI. Factors like underlying comorbidities and hospital stay more significantly affect mortality and amputation rates. Early diagnosis and treatment are recommended to improve patient outcomes.
坏死性软组织感染（NSTI）是一种皮下软组织迅速进展的感染，如果不及时治疗会危及生命。由于发病时症状不具有特异性，诊断往往会延迟，导致高死亡率和截肢风险增加。早期治疗需要手术干预和抗生素治疗。本研究旨在探讨临床参数、应用的治疗方法和初始干预措施对NSTI患者死亡率和截肢率的影响。
在一项回顾性研究中，纳入了2021年至2024年间诊断为NSTI的50例患者。分析了患者的人口统计学特征（年龄、性别、合并症）、分离出的微生物、使用的抗生素、进行的干预措施以及最终结局。此外，还检查了坏死性筋膜炎实验室风险指标（LRINEC）评分、重症监护病房（ICU）住院时间、住院时间、死亡率和截肢率。
本研究的50例患者中，NSTI导致的死亡率为20%（10例患者），截肢率为60%（30例患者）。住院时间和ICU住院时间均与死亡率显著相关。发现糖尿病（DM）与截肢显著相关。LRINEC评分、慢性肾衰竭的存在、脓毒症、高压氧治疗（HBOT）、吸烟以及手术干预时机与截肢率无显著关联。最常见的分离微生物是化脓性链球菌。
尽管LRINEC评分被广泛使用，但它在NSTI的管理中并不起关键作用。潜在合并症和住院时间等因素对死亡率和截肢率的影响更为显著。建议早期诊断和治疗以改善患者结局。
