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Necrotizing Fasciitis: A Predictable Burden in Rural Kenya

  • Surgery in Low and Middle Income Countries
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Necrotizing fasciitis (NF) is a devastating disease with substantial morbidity and mortality. Poor outcomes are attributed to delayed diagnosis and management. Tenwek Hospital, a teaching and referral center in rural Kenya, manages many cases despite variable resources. We aimed to understand the burden of NF.

Methods

All patients with admission NF diagnosis who presented in 2017 were reviewed for demographics, investigations, treatment, and outcomes. The primary outcome was unfavorable outcome defined as in-hospital mortality or amputation. Secondary outcomes were discharge diagnosis of NF and cost. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was calculated. Logistic regression models were utilized to assess the impact of risk factors.

Results

Sixty-seven patients were identified with an average age of 49.2 (±21) years. Medical comorbidities were present in 48% and history of trauma in 58%. Discharge diagnosis of NF occurred in 61% (N = 41). Overall, mortality occurred in 10% (N = 7) of patients with an initial NF diagnosis. At discharge, patients without NF had favorable outcomes in 96% (N = 25) compared to 78% (N = 32) with NF (p = 0.043). Final NF diagnosis costs 122,098 Kenyan Shillings more (95% confidence interval 36,142–208,054) than non-NF diagnosis (p value = 0.006). Factors associated with unfavorable outcome include diabetes mellitus, any comorbidity, increased heart rate, fever, hyperglycemia, anemia, and discharge NF diagnosis. Increased LRINEC score was associated with discharge NF diagnosis (p = 0.0006) and unfavorable outcome (p = 0.0157).

Conclusions

Patients with NF in rural Kenya experience delays to presentation, unfavorable outcomes, and substantial costs. Certain factors, including LRINEC score, help predict diagnosis and outcome.

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Abbreviations

ICD:

International Coding of Disease

LRINEC:

Laboratory Risk Indicator for Necrotizing Fasciitis

NF:

Necrotizing fasciitis

References

  1. Stevens DL, Bryant AE (2017) Necrotizing soft-tissue infections. N Engl J Med 377:2253–2265

    Article  Google Scholar 

  2. Wong C-H, Wang Y-S (2005) The diagnosis of necrotizing fasciitis. Curr Opin Infect Dis 18:101–106

    Article  Google Scholar 

  3. Sartelli M, Malangoni MA, May AK et al (2014) World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections. World J Emerg Surg 9:57. https://doi.org/10.1186/1749-7922-9-57

    Article  PubMed  PubMed Central  Google Scholar 

  4. Morgan M (2010) Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect 75:249–257

    Article  CAS  Google Scholar 

  5. Taviloglu K, Yanar H (2007) Necrotizing fasciitis: strategies for diagnosis and management. World J Emerg Surg 2:19. https://doi.org/10.1186/1749-7922-2-19

    Article  PubMed  PubMed Central  Google Scholar 

  6. Francis K, Lamaute H, Davis J et al (1993) Implications of risk factors in necrotizing fasciitis. Am Surg 59:304–308

    CAS  PubMed  Google Scholar 

  7. Park K-H, Jung S-I, Jung Y-S et al (2009) Marine bacteria as a leading cause of necrotizing fasciitis in coastal areas of South Korea. Am J Trop Med Hyg 80:646–650

    Article  Google Scholar 

  8. Rieger UM, Gugger CY, Farhadi J et al (2007) Prognostic factors in necrotizing fasciitis and myositis: analysis of 16 consecutive cases at a single institution in Switzerland. Ann Plast Surg 58:523–530

    Article  CAS  Google Scholar 

  9. Goh T, Goh L, Ang C et al (2014) Early diagnosis of necrotizing fasciitis. Br J Surg 101:e119–e125

    Article  CAS  Google Scholar 

  10. Elliott DC, Kufera JA, Myers RA (1996) Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg 224:672

    Article  CAS  Google Scholar 

  11. Wong C-H, Khin L-W, Heng K-S et al (2004) The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 32:1535–1541

    Article  Google Scholar 

  12. Wall DB, Klein SR, Black S et al (2000) A simple model to help distinguish necrotizing fasciitis from nonnecrotizing soft tissue infection. J Am Coll Surg 191:227–231

    Article  CAS  Google Scholar 

  13. McHenry CR, Piotrowski JJ, Petrinic D et al (1995) Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 221:558

    Article  CAS  Google Scholar 

  14. El-Menyar A, Asim M, Mudali IN et al (2017) The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring: the diagnostic and potential prognostic role. Scand J Trauma Resusc Emerg Med 25:28

    Article  Google Scholar 

  15. Bilton BD, Zibari GB, McMillan RW et al (1998) Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study/discussion. Am Surg 64:397

    CAS  PubMed  Google Scholar 

  16. van Stigt SF, de Vries J, Bijker JB et al (2016) Review of 58 patients with necrotizing fasciitis in the Netherlands. World J Emerg Surg 11:21. https://doi.org/10.1186/s13017-016-0080-7

    Article  PubMed  PubMed Central  Google Scholar 

  17. Jabbour G, El-Menyar A, Peralta R et al (2016) Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital. World J Emerg Surg 11:40. https://doi.org/10.1186/s13017-016-0097-y

    Article  PubMed  PubMed Central  Google Scholar 

  18. Magala J, Makobore P, Makumbi T et al (2014) The clinical presentation and early outcomes of necrotizing fasciitis in a Ugandan Tertiary Hospital—a prospective study. BMC Res Notes 7:476

    Article  Google Scholar 

  19. Legbo JN, Shehu BB (2005) Necrotizing fasciitis: a comparative analysis of 56 cases. J Natl Med Assoc 97:1692

    PubMed  PubMed Central  Google Scholar 

  20. Sadasivan J, Maroju NK, Balasubramaniam A (2013) Necrotizing fasciitis. Indian J Plast Surg 46:472–478

    Article  Google Scholar 

  21. Kao LS, Lew DF, Arab SN et al (2011) Local variations in the epidemiology, microbiology, and outcome of necrotizing soft-tissue infections: a multicenter study. Am J Surg 202:139–145

    Article  Google Scholar 

  22. Khamnuan P, Chongruksut W, Jearwattanakanok K et al (2015) Necrotizing fasciitis: risk factors of mortality. Risk Manag Healthc Policy 8:1

    PubMed  PubMed Central  Google Scholar 

  23. Lieberman JA, Stansbury LG, Kufera JA et al (2018) Red blood cell transfusions and anemia on admission are associated with poor outcomes in necrotizing soft tissue infections. J Appl Lab Med 2017:025643

    Google Scholar 

  24. Chen P-C, Tsai S-H, Wang J-C et al (2019) An elevated glycemic gap predicts adverse outcomes in diabetic patients with necrotizing fasciitis. PLoS ONE 14:e0223126

    Article  CAS  Google Scholar 

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Funding

There was no funding dedicated to this study.

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Authors and Affiliations

  1. Department of Surgery, Tenwek Hospital, P.O. Box 39, Bomet, 20400, Kenya

    Joyce Lunar, Sinkeet S. Ranketi, Beverly Owino, Mark Oloo & Robert K. Parker

  2. Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA

    Robert K. Parker

Authors
  1. Joyce Lunar
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  2. Sinkeet S. Ranketi
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  3. Beverly Owino
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  4. Mark Oloo
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  5. Robert K. Parker
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Contributions

All authors contributed to meet all four requirements of ICJME recommendations. JL, SR, BO, MO, and RP contributed to the concept and design of the project or to data acquisition, analysis, and interpretation. JL and RP drafted the initial manuscript and each author offered revisions for important intellectual content. All authors approved the final manuscript and accept responsibility. The primary author, JL, confirms that she had full access to the data and the final responsibility for the decision to submit for publication.

Corresponding author

Correspondence to Robert K. Parker.

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Conflict of interest

All authors declare that they have no conflict of interest.

Availability of data and materials

The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Not applicable.

Ethics approval

The study was approved by the Institutional Ethical Review Committee of Tenwek Hospital.

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Lunar, J., Ranketi, S.S., Owino, B. et al. Necrotizing Fasciitis: A Predictable Burden in Rural Kenya. World J Surg 44, 2919–2926 (2020). https://doi.org/10.1007/s00268-020-05581-4

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  • DOI: https://doi.org/10.1007/s00268-020-05581-4

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