EVALUATION OF NECROTIZING FASCIITIS IN DIABETIC AND NON-DIABETIC ADULT PATIENT

Abstract

Background: Necrotizing fasciitis (NF), often referred to as "flesh-eating disease," is a severe and rapidly progressing infection affecting the deep fascia and subcutaneous tissues. It can occur anywhere on the body, frequently stemming from minor trauma or surgical wounds. However, in up to half of cases, a definitive cause remains unidentified. Several comorbid conditions, including diabetes mellitus (DM), obesity, and smoking, are associated with an increased risk of developing NF. Diabetic patients, due to compromised wound healing and heightened susceptibility to infection, are believed to have more severe outcomes from NF.[1]

Aims and Objectives: This study aimed to evaluate necrotizing fasciitis (NF) in adult patients, specifically examining the influence of age, sex, symptom duration, affected body site, predisposing factors, causative organisms, length of hospital stay, and overall outcomes. A key focus was the comparison of these factors between diabetic and non-diabetic patient groups.

Methods: A prospective, hospital-based study was conducted at VIMSAR, Burla, Sambalpur, Odisha, between November 2022 and October 2024. Participants included all patients diagnosed with necrotizing fasciitis and admitted to the Department of General Surgery during the study period. Data collected pertained to demographic information, clinical presentation, predisposing factors, causative microorganisms, treatment strategies, and patient outcomes. The data were then analysed using appropriate statistical methods.

Results :The findings of this study indicated that older individuals are disproportionately affected by necrotizing fasciitis. Within the age range of 51 to 60 years, diabetic patients were most commonly affected, compared to 41-50 years for those without diabetes. Male patients were more frequently affected than females across both patient groups. While the aetiology of infection was often idiopathic in diabetic patients, minor trauma was a more a prominent precipitating factor in the non-diabetic group. The lower extremity was the most commonly involved site in all patients. In diabetic patients, Staphylococcus species and E. coli were commonly isolated, while Klebsiella spp. were frequently identified in the non-diabetic group. Diabetic patients experienced significantly higher mortality rates and longer lengths of hospital stay. Serial surgical debridement was a necessary treatment for most, and mortality was notably higher in diabetic patients who presented with advanced stages of the disease.

Conclusion: This study confirms that necrotizing fasciitis results in more severe clinical courses in diabetic patients compared to their non-diabetic counterparts. This is evidenced by increased mortality, prolonged hospitalizations, and a greater requirement for surgical debridement. Therefore, early identification and prompt, aggressive management are crucial for improving outcomes, especially in diabetic individuals presenting with this life-threatening condition.