View 2019 Abstracts

Necrotising fasciitis is a serious but rare bacterial condition causing tissue necrosis requiring prompt diagnosis and management. The UK incidence is estimated to be around 0.04/1000 person-years. Our aim was to describe our experience of necrotising fasciitis in the Wye Valley region and evaluate the causative factors, management and outcomes of these patients.

Data on cross-specialty cases admitted to Hereford County Hospital between 2008 and January 2019 was collected using electronic and paper records. Data including anatomical location, investigations and management including antibiotics, surgical intervention and ITU admission were collated and the LRINEC(Laboratory Risk Indicator for Necrotizing Fasciitis) score was calculated.

Hereford Hospital serves a population of 210,000. 30 cases of necrotising fasciitis were treated during this period. Locations of infection included the peri-ocular region, limbs, breast, buttock, groin and the abdomen. Several patients had poly microbial involvement with the majority being infected with anaerobic organisms, namely Group A streptococcus. All patients underwent surgical intervention and ITU stay. The mortality rate was 27%. The average LRINEC score was 7.7, with the highest score being 11.

Necrotising fasciitis is a life threatening condition with an acute reported mortality rate of 17-27%, with some reports as high as 75%. This highlights and reiterates the importance of prompt review, diagnosis and management of these patients. Our case highlights the importance of considering this diagnosis in patients attending eye casualty with a cellulitic picture to ensure appropriate and timely management is undertaken.