M. CHRISTOPHE1, J. Rickard2,4, F. Charles1,3, N. Faustin1,2 1University Of Rwanda,College Of Medicine And Health Sciences,Kigali, KIGALI, Rwanda 2University Teaching Hospital Of Kigali,Surgery,Kigali, , Rwanda 3Rwanda Military Hospital,Plastic And Reconstructive Surgery,Kigali, KIGALI, Rwanda 4University Of Minnesota,Surgery And Critical Care,Minneapolis, MN, USA
Introduction: Necrotizing soft tissue infections (NSTI) is an emergency surgical condition with severe physiologic and metabolic derangement that predisposes the patient to increased mortality and morbidity worldwide, particularly in developing countries if not diagnosed and treated early.
Methods: This prospective observational cohort study includes all patients aged12 and above who presented at Department of Surgery, University Teaching Hospital of Kigali from April 2016 to January 2017 with NSTI. We describe epidemiology, operative management, and outcomes of care. We evaluated the risk factors for mortality using bivariate and multivariate logistic regression.
Results:We identified 175 patients with confirmed diagnosis of NSTI. The majority of patients (53%) were male and the mean age was 44 years. The median duration of symptoms was 8 days (Interquartile range (IQR): 5-14) .The overall mortality was 26%. The median length of hospital stay was 23days (IQR: 8-41). Multivariate regression analysis revealed four independent predictors of mortality: presence of shock at admission (odds ratio (OR) 14.15, 95% confidence interval (CI):0.96-208.01, P=0.05), chronic kidney disease (OR 8.92, 95% CI:1.55-51.29, P=0.01) infection located to the trunk (OR: 5.60 , 95% CI:0.99-31.62, P=0.05), and presence of skin gangrene (OR 4.04, 95% CI: 1.18-13.76, P=0.02).
Conclusion:NSTI mortality is high. Patients present in late stage, which carries increased mortality and morbidity. It is imperative that increased efforts need to be done in regards to early consultation, diagnosis and surgical management to prevent bad outcomes