Dukhabandhu Naik1, Felix K Jebasingh1, Nihal Thomas1, Sreekanth Raveendran2, Samuel C Raj Pallapati3, John Jude Prakash4, Mahasampath Gowri5, Binu Prathap Thomas3. 1. Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, 632004, India. 2. Dr Paul Brand Centre for Hand Surgery, Christian Medical College, Vellore, 632004, India. Electronic address: drsreekanthr@gmail.com. 3. Dr Paul Brand Centre for Hand Surgery, Christian Medical College, Vellore, 632004, India. 4. Department of Microbiology, Christian Medical College, Vellore, 632004, India. 5. Department of Biostatistics, Christian Medical College, Vellore, 632004, India.
Abstract
BACKGROUND: Necrotizing soft tissue infection (NSTI) of the upper extremities is a rare, but potentially life-threatening infection in patients with type 2 diabetes mellitus (T2DM). We analyzed the clinical characteristics and the outcome of NSTI of upper extremities in these patients. METHODS: This was a retrospective study analyzing the clinical characteristics and the outcomes of 33 T2DM patients with NSTI of upper extremities, who were treated in the department of hand surgery between January 2011 and December 2017. RESULTS: Predisposing factors for NSTI were recognized in 16 (48.5%) patients. Eleven (33.3)% patients had septic shock while ten (30.3%) had acute renal insufficiency at the time of presentation, of which six required dialysis. The mean glycosylated hemoglobin was 9.6(±2.6)% and the random plasma glucose at admission was 271(±96) mg/dl. Monomicrobial infection was seen in 16(49%) patients and polymicrobial infection in 9(27%) patients. Gram-positive causation was found in 25(66%) patients. Twelve (36.4%) patients required amputation, six (18.2%) of which were major. Death occurred in more than one-fifth (21.2%) of the patients during treatment. CONCLUSION: Necrotizing soft tissue infection of the upper extremities in T2DM is associated with increased risk of severe infection, amputation and mortality.
BACKGROUND:Necrotizing soft tissue infection (NSTI) of the upper extremities is a rare, but potentially life-threatening infection in patients with type 2 diabetes mellitus (T2DM). We analyzed the clinical characteristics and the outcome of NSTI of upper extremities in these patients. METHODS: This was a retrospective study analyzing the clinical characteristics and the outcomes of 33 T2DM patients with NSTI of upper extremities, who were treated in the department of hand surgery between January 2011 and December 2017. RESULTS: Predisposing factors for NSTI were recognized in 16 (48.5%) patients. Eleven (33.3)% patients had septic shock while ten (30.3%) had acute renal insufficiency at the time of presentation, of which six required dialysis. The mean glycosylated hemoglobin was 9.6(±2.6)% and the random plasma glucose at admission was 271(±96) mg/dl. Monomicrobial infection was seen in 16(49%) patients and polymicrobial infection in 9(27%) patients. Gram-positive causation was found in 25(66%) patients. Twelve (36.4%) patients required amputation, six (18.2%) of which were major. Death occurred in more than one-fifth (21.2%) of the patients during treatment. CONCLUSION:Necrotizing soft tissue infection of the upper extremities in T2DM is associated with increased risk of severe infection, amputation and mortality.
Authors: Susanne Kopp; Wiebke K Peitsch; Assen Mladenov; Katharina Diehl; Oliver Müller; Christian von Heymann Journal: World J Emerg Surg Date: 2022-08-05 Impact factor: 8.165