M. CHRISTOPHE1, J. Rickard2,3, F. Charles1,4, N. Faustin1,3 1University Of Rwanda,College Of Medicine And Health Sciences,Kigali, KIGALI, Rwanda 2University Of Minnesota,Surgery And Critical Care,Minneapolis, MN, USA 3University Teaching Hospital Of Kigali,Surgery,Kigali, KIGALI, Rwanda 4Rwanda Military Hospital,Plastic And Reconstructive Surgery,Kigali, KIGALI, Rwanda
Introduction: Necrotizing soft tissue infections (NSTI) remains a challenging emergency surgical condition with rapid clinical deterioration, microbiological variability and increased morbidity and mortality
Methods: This prospective cohort study includes all patients managed in Department of Surgery, University Teaching Hospital of Kigali (CHUK) from April 2016 to January 2017 with NSTI. The objective was to describe patients’ demographics, involved tissue planes, bacterial pathogens involved, antimicrobial sensitivity patterns and outcome of care. Analyses were conducted using student t-test for continuous variables and Pearson chi-square test for categorical variables. P-value < 0.05 was considered significant
Results:A cohort of 175 patients with confirmed diagnosis of NSTI was recruited during the study period. Monomicrobial organisms were identified in 57% of cases: Klebsiella spp (n=28, 16%), Escherichia coli (n=22, 13%, Proteus spp (n=20, 11%, and Staphylococcus aureus (n= 19, 11%. Fifty one (29 %) patients had no bacterial growth. The overall isolated germs were gram negative (n=121, 81%) with predominance of klebsiella spp (n=38, 25%). Third generation cephalosporins were prescribed in 136 (78%) patients. Forty to sixty five (40-65%) of commonly isolated organisms (klebsiella spp, Escherichia coli) were resistant to most used antibiotics (third generation cephalosporins). The overall mortality was 26%. The median length of hospital stay was 23days (IQR: 8-41).
Conclusion:NSTIs are found to be predominantly mono-microbial with high resistance to 3rd generation cepahalosporins. A large scale antibiogram study is needed to guide clinician decision making for empirical antibiotic coverage in NSTI in order to improve patients’ outcomes.