NECROTIZING SOFT TISSUE INFECTION BY SERRATIA MARCESCENS: AN EARLY DIAGNOSIS WITH THE UTILIZATION OF LABORATORY RISK INDICATOR FOR NECROTIZING FASCIITIS (LRINEC) SCORE

Background: Necrotizing soft tissue infection (NSTI) is an uncommon but life threatening disease with a high mortality rate. Delay in diagnoses and in surgery for debridement is associated with increased mortality rates. Hence here we would like to use this scoring system - laboratory risk indicator for necrotizing fasciitis (LRINEC) in patients presenting to our hospital with necrotizing soft tissue infection and if found to have good predictive values, it would be a boon to developing countries like India where the mortality of the disease is high (7% to 76%).Methods: Patients presenting with symptoms suggestive of soft tissue infection underwent clinical examination and basic laboratory investigations. Following which, information collected using semi structured proforma cum observational checklist. LRINEC scoring system applied to each of the study subjects at admission. The confirmatory diagnosis of necrotizing fasciitis done on patients who undergo surgery vide histopathology, irrespective of the result of the LRINEC scoring system. Tissue cultures and sensitivity patterns analyzed.Results: A total of 100 patients were enrolled. LRINEC score has an ability to diagnose necrotizing fasciitis from other soft tissue infections. High LRINEC score had more incidences of features of sepsis. Presence of the co morbidities tended to increase the LRINEC score. And defines patients with a high LRINEC score of >8 had higher mortality rate.Conclusions: LRINEC score is a simple clinical tool for the diagnosis of necrotizing fasciitis from other soft tissue infections. LRINEC scoring system and clinical assessment should be used concurrently for diagnosing necrotizing fasciitis from other soft tissue infections.

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Clinical and laboratory risk indicator for necrotizing fasciitis score in predicting the outcomes in necrotizing soft tissue infection patients

International Surgery Journal ◽

10.18203/2349-2902.isj20202395 ◽

2020 ◽

Vol 7 (6) ◽

pp. 1852

Author(s):

Madhusoodan Gupta ◽

Aditya Aggarwal ◽

Hardeep Singh ◽

Rakesh K. Khazanchi ◽

Sanjay Mahendru ◽

...

Keyword(s):

Soft Tissue ◽

Necrotizing Fasciitis ◽

Soft Tissue Infection ◽

Length Of Hospital Stay ◽

Tissue Infection ◽

Risk Indicator ◽

Necrotizing Soft Tissue Infection ◽

Mortality And Morbidity ◽

Lrinec Score ◽

High Index Of Suspicion

Background: Necrotizing soft tissue infection (NSTI) is a serious condition that can be diagnosed on a high index of suspicion and require urgent surgical treatment. NSTI involved epidermis and dermis but more frequently it affects the deeper layer of adipose tissue, fascia, and muscle. NSTI diagnosis and its treatment include emergent surgical intervention and the use of appropriate antibiotics. In this study, we have been evaluated the laboratory risk indicator for necrotizing fasciitis (LRINEC) score in predicting the outcomes in patients of NSTI.Methods: We have conducted a prospective study of 36 patients with NSTI. The LRINEC score, predisposing factors, etiology, risk factors, causative microbiological organisms have been studied.Results: LRINEC score >8 is associated with NSTI in all cases. The mortality and morbidity, length of stay including ICU stay increases with an increase in LRINEC score. The most common microorganism was found to be E. coli followed by Klebsiella.Conclusions: Although, we used the emergent and liberal debridement and appropriate antibiotic and resuscitation. In this study, morbidity, mortality, and length of hospital stay all are increased with respect to the increase in LRINEC score.

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Does the Laboratory Risk Indicator for Necrotizing Fasciitis Score Have Utility in Immunocompromised Patients with Necrotizing Soft Tissue Infection?

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2017.07.106 ◽

2017 ◽

Vol 225 (4) ◽

pp. S54

Author(s):

Manuel Castillo-Angeles ◽

Ramsis Ramsis ◽

Nathan Blecker ◽

Monica G. Valero ◽

Emily Z. Keung ◽

...

Keyword(s):

Soft Tissue ◽

Necrotizing Fasciitis ◽

Soft Tissue Infection ◽

Tissue Infection ◽

Risk Indicator ◽

Immunocompromised Patients ◽

Necrotizing Soft Tissue Infection

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The association between laboratory risk indicator for necrotizing fasciitis score with clinical signs and symptoms of necrotizing fasciitis: a retrospective study

International Surgery Journal ◽

10.18203/2349-2902.isj20211822 ◽

2021 ◽

Vol 8 (5) ◽

pp. 1532

Author(s):

Ajay Chauhan ◽

Yashashvi Patel ◽

Amit S. Chauhan ◽

Fateh S. Mehta

Keyword(s):

Soft Tissue ◽

Necrotizing Fasciitis ◽

Soft Tissue Infection ◽

Randomized Study ◽

Clinical Signs ◽

Tissue Infection ◽

Anatomical Location ◽

Risk Indicator ◽

Good Tool ◽

Lrinec Score

Background: The term necrotizing soft tissue infection encompassing simple pyoderma to life threatening infection, varying with regards to anatomical location, tissue involvement and offending organism. Early diagnosis of necrotizing-STI is important for timely surgical intervention, but physical findings can vary, so misdiagnosis is common. By using WBC, CRP, haemoglobin, Na, creatinine, glucose and clinical examination we can distinguish NF from other STI.Methods: This was a retrospective and randomized study in the Geetanjali Medical College and Hospital affiliated to Geetanjali University from January 2017 to January 2019 during this period total 66 patients with soft tissue Infection were admitted and included. Clinical details and investigations were recorded from the case sheet and were analyzed with WBC, CRP, Hb, Na, creatinine and glucose.Results: The most commonly affected age group was 46-60 years with male preponderance. Most common cause of STI was Trauma 66.66% of the patients having Primary Site Lower Limb in 12.12% and as per LRINEC score 50% of the patients have low risk, 37.87% of the patients have high risk and strongly in favour of NF and 12.12% of the patients have intermediate risk.Conclusions: The LRINEC score is a good tool for NF risk stratification and patients are advised to be careful for presence of NF if LRINEC score is≥6.

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A study on role of laboratory risk indicator for necrotizing fasciitis score in necrotizing fasciitis

International Surgery Journal ◽

10.18203/2349-2902.isj20194575 ◽

2019 ◽

Vol 6 (11) ◽

pp. 3901

Author(s):

Narendra Prasad Narsingh ◽

Anjana Nigam ◽

Ramesh Kumar

Keyword(s):

Soft Tissue ◽

Necrotizing Fasciitis ◽

Soft Tissue Infection ◽

Age Groups ◽

Clinical Findings ◽

High Risk Group ◽

Tissue Infection ◽

Risk Indicator ◽

Early Management ◽

Lrinec Score

Background: Necrotizing fasciitis (NF) represents a group of highly lethal infection characterized by rapidly progressing inflammation and necrosis. The spectrum of disease ranges from necrosis of the skin to life threatening infection. Laboratory risk indicator for necrotizing fasciitis (LRINEC) score is only scoring system available so far to help us towards making an early and accurate diagnosis.Methods: The current prospective observational study was conducted in the Surgery OPD and emergency, Department of surgery, Dr. B.R. Ambedkar Memorial Hospital, Raipur, CG, India, during study period October 2017 to September 2018. Sample size was fixed at 100. Blood tests taken on admission were used to calculate the LRINEC score in each case.Results: In this study 55% of patients with soft tissue infections were categorized as low risk for progression of NF. Necrotizing soft tissue infection (NSTI) occurs in all age groups, ranging from 18 to 75 years. Clinical findings of crepitus were found in 33% of all patients of NSTI. 96% of the patients underwent debridement once, debridement was done twice in 3% of the patients while debridement was not done in 1% of the patients who belonged to high risk group and had no comorbidities. Out of 100, 3 patients underwent amputation. We found that there is mortality rate of 5%.Conclusions: NF was most severe form of soft tissue infection, potentially life and limb threatening. Early diagnosis of NF is essential for early management and better prognosis of patients.

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Necrotizing Soft Tissue Infection Caused by Serratia marcescens in a Patient Treated with Tocilizumab

Kansenshogaku zasshi ◽

10.11150/kansenshogakuzasshi.89.53 ◽

2015 ◽

Vol 89 (1) ◽

pp. 53-55 ◽

Cited By ~ 1

Author(s):

Hiroo MATSUO ◽

Kyoko KOSAKA ◽

Kentaro IWATA ◽

Goh OHJI

Keyword(s):

Soft Tissue ◽

Serratia Marcescens ◽

Soft Tissue Infection ◽

Tissue Infection ◽

Necrotizing Soft Tissue Infection

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Evaluation of laboratory risk indicator for necrotizing fasciitis (Lrinec) scoring system for diagnosis of necrotizing fasciitis in patients presenting with soft tissue infection

International Journal of Case Reports ◽

10.28933/ijcr-2020-08-1106 ◽

2020 ◽

pp. 155

Author(s):

Keyword(s):

Soft Tissue ◽

Necrotizing Fasciitis ◽

Soft Tissue Infection ◽

Scoring System ◽

Tissue Infection ◽

Risk Indicator

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Hepatitis influences the diagnosis of Necrotising soft-tissue infection: A proposed modification to the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score from a retrospective study at a single institution

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2020.08.027 ◽

2020 ◽

Author(s):

Kiichi Furuse ◽

Motoi Kato ◽

Yuya Morishita ◽

Tomoyo Kumagai ◽

Shuichi Nakatsukasa ◽

...

Keyword(s):

Retrospective Study ◽

Soft Tissue ◽

Soft Tissue Infection ◽

Tissue Infection ◽

Necrotising Fasciitis ◽

Risk Indicator ◽

Single Institution ◽

Lrinec Score ◽

Proposed Modification

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Necrotising soft tissue infection in a UK metropolitan population

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x14055925058553 ◽

2015 ◽

Vol 97 (1) ◽

pp. 46-51 ◽

Cited By ~ 36

Author(s):

GE Glass ◽

F Sheil ◽

JC Ruston ◽

PEM Butler

Keyword(s):

Soft Tissue ◽

Soft Tissue Infection ◽

Young Patients ◽

Retrospective Chart Review ◽

Tissue Infection ◽

Teaching Hospitals ◽

Risk Indicator ◽

First Line ◽

Group A ◽

Lrinec Score

Introduction Necrotising soft tissue infection (NSTI) is a rare but life threatening diagnosis. Geographic, economic and social variances influence presentation and prognosis. As the current literature does not reflect a UK metropolitan population, we conducted a retrospective chart review to establish pertinent features relevant to our practice. Methods Patients with histologically confirmed diagnoses of NSTI presenting to two London teaching hospitals between January 2007 and July 2013 were included in the study. Features of presentation, surgical and medical management, microbiological findings and outcome were evaluated. Results Twenty-four patients with histologically confirmed NSTI were included. Two age clusters were identified, with means of 46 years (standard deviation [SD]: 10 years) and 80 years (SD: 6 years). Pain, erythema and sepsis were common findings. Hypertension, hypercholesterolaemia and type II diabetes mellitus were common co-morbidities. A third of younger patients had human immunodeficiency virus or hepatitis C, with a quarter dependent on drugs and/or alcohol. The mean Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score was 5.8 (SD: 3.3). The lower extremities, groin and perineum were common sites of infection. Fourteen patients required inotropic support and seventeen required transfusions. The median number of surgical procedures was 5 (range: 1–17). Group A Streptococcus was the most frequently identified pathogen. Five patients died. Being elderly, female sex and failure to use clindamycin as a first-line antibiotic were associated with significantly higher mortality. Conclusions In contrast to other recent series, group A streptococcal monomicrobial NSTI remains the most common presentation in our population. Survival is anticipated in young patients, regardless of premorbid status. Elderly patients have a poor prognosis. The negative predictive value of the LRINEC score is questioned. Use of clindamycin as a first-line antibiotic is supported.

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