Implementation of a standardized management protocol improved the survival of patients with necrotizing fasciitis
Journal
Formosan Journal of Surgery
Series/Report No.
Formosan Journal of Surgery
Journal Volume
57
Journal Issue
5
Start Page
173-180
ISSN
1682-606X
2213-5413
Date Issued
2024-09-01
Author(s)
DOI
10.1097/FS9.0000000000000122
Abstract
Background: Necrotizing fasciitis (NF) is a life-threatening soft tissue infection requiring urgent interventions. This study aimed to investigate the effect of implementation of a standardized management protocol on the outcome of NF patients admitted to the intensive care unit. Materials and Methods: We initiated a management protocol for NF patients in 2012 at our institution. The protocol consisted of early surgical intervention, initial board-spectrum antibiotic regimen, daily wound inspection, repeated debridement, and interprofessional collaboration. Herein, we reviewed the NF cases admitted between 2005 and 2018 and compared their clinical features and outcome before and after the protocol implementation. All of the NF cases were confirmed by intraoperative findings. Results: We included 134 NF patients before (2005 to 2011, n = 62) and after (2013 to 2018, n = 72) the protocol implementation. The baseline patient profile from these 2 periods was largely similar, except that after protocol implementation, more patients presented with erythema (64.5% vs 84.7%) and a higher C-reactive protein level (65.5% vs 85.5%) on admission. Notably, the day 28-censored mortality was significantly lower after protocol implementation (40.3% vs 13.9%). By analyzing the 28-day mortality with univariate and multivariate model, initial presentation with neutropenia was identified as a risk factor [hazard ratio (HR) = 8.45, 95% confidence interval (CI) = 1.76-40.6], while protocol implementation (HR = 0.27, 95% CI = 0.11-0.71) was a protective factor. Conclusions: A multidisciplinary bundle care protocol for NF including board-spectrum empirical antibiotic regimen and interprofessional collaboration was feasible, which was associated with improved overall and 28-day survival. Copyright © 2024 Taiwan Surgical Association. Published by Wolters Kluwer Health, Inc. on behalf of Taiwan Surgical Association.
Subjects
Management protocol
Mortality
Necrotizing fasciitis
Necrotizing soft tissue infections
Risk factor
Publisher
Ovid Technologies (Wolters Kluwer Health)
Type
journal article