1528. Evaluation of Missed/Delayed Opportunities for Management of Necrotizing Fasciitis at a Medical Center in East Baltimore
Session: Poster Abstract Session: Clinical Infectious Diseases: Soft Tissue Infections (ABSSSIs)
Saturday, October 10, 2015
Room: Poster Hall
Background: Necrotizing fasciitis (NF) is a devastating, rapidly aggressive infection with high mortality and morbidity. Early diagnosis and surgical management is critical. Evaluating missed/delayed opportunities for management are a first step in improving timely recognition and outcomes. Methods: We reviewed all patients diagnosed with NF at Johns Hopkins Bayview between Oct. 2009 Dec. 2014. We assessed for missed/delayed opportunities for diagnosis and management. We used survival analysis and Cox proportional hazard model to evaluate time to diagnosis and factors associated with survival. Results: Fifty-two patients were diagnosed with NF with lesions most commonly located on an extremity, 31 (59.6%), followed by the perineum, 16 (30.8%). Delays in diagnosis occurred in 75% of cohort with 19% overall mortality. Microbiology demonstrated 51.9% polymicrobial with predominance of Group A Streptococcus species and 37.0% monomicrobial organism, with the majority being S. aureus MSSA/MRSA. Red blood cell distribution width (RDW) and lowest admission systolic blood pressures were associated with 37% increased [adjusted odds ratio (aOR): 1.37; 95% confidence interval (CI), 1.01, 1.98] and 9% reduced [aOR: 0.91; CI, 0.83, 0.99] risk of mortality respectively. Median time to surgery from ED presentation was 10.4 hours [95% CI, 1.8, 380.4], while median time to surgery after NF diagnosis was 2.5 hours [95% CI, -19.6, 36.8] Infectious Disease specialist consultation (IDC) appeared to be associated with improved patient outcomes (adjusted hazard ratio (aHR) 0.05; 95% CI, 0.00, 0.68). Median time from presentation to IDC was: 70.0 hours [95% CI, 0.0, 431.9]. Conclusion: Although current recommendations for management of necrotizing fasciitis include prompt initiation of antibiotics and surgical intervention, delays in NF diagnosis and management persists. Multidisciplinary management approach (e.g. consultation of subspecialist) and developing sensitive prediction rules may have a role in improving outcomes among patients with necrotizing fasciitis.
N'dama Bamba, MD1, Jennifer Townsend, MD2 and Jonathan M. Zenilman, MD, FIDSA1, (1)Johns Hopkins University School of Medicine, Baltimore, MD, (2)Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD

Disclosures:

N. Bamba, None

J. Townsend, None

J. M. Zenilman, None

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