Differentiating necrotizing soft tissue infections from cellulitis by soft tissue infectious fluid analysis: a pilot study

Abstract Background We conducted this study to evaluate the characteristics of the infectious fluid in soft tissue infection and investigate the utility of the biochemical tests and Gram stain smear of the infectious fluid in distinguishing necrotizing soft tissue infection (NSTI) from cellulitis. Methods This retrospective cohort study was conducted in a tertiary care hospital in Taiwan. From April 2019 to October 2020, patients who were clinically suspected of NSTI with infectious fluid accumulation along the deep fascia and received successful ultrasound-guided aspiration were enrolled. Based on the final discharge diagnosis, the patients were divided into NSTI group, which was supported by the surgical pathology report, or cellulitis group. The t test method and Fisher’s exact test were used to compare the difference between two groups. The receiver–operator characteristic (ROC) curves and area under the ROC curve (AUC) were used to evaluate the discriminating ability. Results Total twenty-five patients were enrolled, with 13 patients in NSTI group and 12 patients in cellulitis group. The statistical analysis showed lactate in fluid (AUC = 0.937) and LDH in fluid (AUC = 0.929) had outstanding discrimination. The optimal cut-off value of fluid in lactate was 69.6 mg/dL with corresponding sensitivity of 100% and specificity of 76.9%. The optimal cut-off value of fluid in LDH was 566 U/L with corresponding sensitivity of 83.3% and a specificity of 92.3%. In addition, albumin in fluid (AUC = 0.821), TP in fluid (AUC = 0.878) and pH in fluid (AUC = 0.858) also had excellent diagnostic accuracy for NSTI. The Gram stain smear revealed 50% bacteria present in NSTI group and all the following infectious fluid culture showed bacteria growth. Conclusions The analysis of infectious fluid along the deep fascia might provide high diagnostic accuracy to differentiate NSTI from cellulitis.

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A PROSPECTIVE STUDY TO ASSESS THE DIAGNOSTIC EFFICACY OF LABORATORY RISK INDICATOR FOR NECROTIZING FASCIITIS (LRINEC) SCORING SYSTEM IN PATIENTS WITH SOFT TISSUE INFECTION

10.36106/gjra/5206015 ◽

2020 ◽

pp. 37-39

Author(s):

K. Vani ◽

Gattupalli Bhaswanth Kumar Reddy ◽

B. Jayakiran ◽

J. Ramanaiah ◽

B. Balaji ◽

...

Keyword(s):

Soft Tissue ◽

Prospective Study ◽

Necrotizing Fasciitis ◽

Soft Tissue Infection ◽

Histopathological Examination ◽

Tertiary Care ◽

Tissue Infection ◽

Risk Indicator ◽

Care Hospital ◽

A Prospective Study

Background Necrotizing fasciitis which is commonly known as “Flesh-Eating Disease” is an uncommon soft-tissue infection. It is characterized by widespread fascial necrosis with relative sparing of overlying skin and underlying muscle. Mostly it is associated with severe systemic toxicity and a fulminant course. It is usually rapidly fatal unless promptly recognized and aggressively treated with appropriate antimicrobials and surgical debridement at the earliest. Methods Our study was a prospective study conducted on 140 patients over a period of 2 years from June 2018 to June 2020 in a tertiary care hospital, GGH, Kadapa. All patients were selected randomly and evaluated by taking proper history, thorough clinical examination, routine laboratory investigations and histopathological examination of the debrided tissue and the outcomes were analysed to know the efficacy of LRINEC Scoring in diagonising necrotizing fasciitis. Results Most common age group was 41-50 years. Males were commonly affected, accounting to 74% i.e., 111 patients and the remaining 39 patients were females (39%). Fever, inflammation of the involved area were the most common presentations. Majority were diabetic and hypertensive accounting to 55.3% and 52.7% respectively. All patients presented with symptoms with swelling, redness, pain and induration. Eighty-one percent had elevated CRP. Total WBC count was raised in 78.7% of the cases. Fifty-six percent of the cases had haemoglobin less than 11g/dl. Hyponatremia was observed in 81.3% of the patients. Majority (52.7%) had normal sr. creatinine i.e., < or =1.4. RBS was elevated in 54.7% of the cases. In our study 87.3% of the patients had a LRINEC score >6. Histology was positive for necrotising fasciitis in 92% of the cases, among them majority had polymicrobial organisms on culture. Conclusion In patients with severe soft tissue infections, LRINEC scoring based on laboratory parameters is an easy and reliable diagnostic tool to diagnose Necrotizing fasciitis accurately.

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Clinical Profile and Outcome of Patients Suffering from Soft Tissue Infection in Lower Limb Disease in the Department of Surgery in Tertiary Care Center

International Journal of Contemporary Surgery ◽

10.5958/2321-1024.2019.00035.7 ◽

2019 ◽

Vol 7 (2) ◽

pp. 121

Author(s):

Rishabh Sharma ◽

Ram Kumar Verma ◽

Alok Vardhan Mathur ◽

Rajendra Kumar Srivastava ◽

Saurabh Kumar

Keyword(s):

Soft Tissue ◽

Soft Tissue Infection ◽

Lower Limb ◽

Care Center ◽

Tertiary Care ◽

Tissue Infection ◽

Clinical Profile ◽

Tertiary Care Center

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LO50: Necrotizing soft tissue infection: diagnostic accuracy of physical examination, imaging and LRINEC score a systematic review and meta-analysis

CJEM ◽

10.1017/cem.2018.112 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S24-S24 ◽

Cited By ~ 1

Author(s):

S. M. Fernando ◽

A. Tran ◽

W. Cheng ◽

M. Taljaard ◽

B. Rochwerg ◽

...

Keyword(s):

Soft Tissue ◽

Diagnostic Accuracy ◽

Soft Tissue Infection ◽

Meta Analysis ◽

Plain Radiography ◽

Tissue Infection ◽

Physical Exam ◽

Necrotizing Soft Tissue Infection ◽

Lrinec Score ◽

Rule Out

Introduction: Necrotizing soft tissue infection (NSTI), a potentially life-threatening diagnosis, is often not immediately recognized by clinicians. Delays in diagnosis are associated with increased morbidity and mortality. We sought to summarize and compare the accuracy of physical exam, imaging, and Laboratory Risk Indicator of Necrotizing Fasciitis (LRINEC) Score used to confirm suspected NSTI in adult patients with skin and soft tissue infections. Methods: We searched Medline, Embase and 4 other databases from inception through November 2017. We included only English studies (randomized controlled trials, cohort and case-control studies) that reported the diagnostic accuracy of testing or LRINEC Score. Outcome was NSTI confirmed by surgery or histopathology. Two reviewers independently screened studies and extracted data. We assessed risk of bias using the Quality Assessment of Diagnostic Accuracy Studies 2 criteria. Diagnostic accuracy summary estimates were obtained from the Hierarchical Summary Receiver Operating Characteristic model. Results: We included 21 studies (n=6,044) in the meta-analysis. Of physical exam signs, pooled sensitivity and specificity for fever (49.4% [95% CI: 41.4-57.5], 78.0% [95% CI: 52.2-92.0]), hemorrhagic bullae (30.8% [95% CI: 16.2-50.6], 94.2% [95% CI: 82.9-98.2]) and hypotension (20.8% [95% CI: 7.7-45.2], 97.9% [95% CI: 89.1-99.6]) were generated. Computed tomography (CT) had 88.5% [95% CI: 55.5-97.9] sensitivity and 93.3% [95% CI: 80.8-97.9] specificity, while plain radiography had 48.9% [95% CI: 24.9-73.4] sensitivity and 94.0% [95% CI: 63.8-99.3] specificity. Finally, LRINEC 6 (traditional threshold) had 67.5% [95% CI: 48.3-82.3] sensitivity and 86.7% [95% CI: 77.6-92.5] specificity, while a LRINEC 8 had 94.9% [95% CI: 89.4-97.6] specificity but 40.8% [95% CI: 28.6-54.2] sensitivity. Conclusion: The absence of any one physical exam feature (e.g. fever or hypotension) is not sufficient to rule-out NSTI. CT is superior to plain radiography. The LRINEC Score had poor sensitivity, suggesting that a low score is not sufficient to rule-out NSTI. For patients with suspected NSTI, further evaluation is warranted. While no single test is sensitive, patients with high-risk features should receive early surgical consultation for definitive diagnosis and management.

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