To investigate the clinical characteristics of necrotizing soft tissue infection (NSTI) and the clinical therapeutic effect of comprehensive sequential diagnosis and treatment strategy.

The clinical medical records of NSTI patients treated with comprehensive sequential diagnosis and treatment strategies in the Third Ward of Senior Department of Burns and Plastic Surgery, Fourth Medical Center of PLA General Hospital from January 2016 to May 2021 were retrospectively analyzed. The comprehensive sequential diagnosis and treatment strategies included prompt diagnosis, systemic therapy, early and repeated debridement combined with negative pressure wound therapy with instillation( NPWTi) and sequential wound closing. The clinical characteristics including general data (gender, age, history of diabetes, etiology, wound site, etc.), pathogenic bacteria of wound infection and type of NSTI were collected. The treatment data of patients including the wound healing situation (cured, improved or unhealed), amputation situation, colostomy or not, and the number of operations, the NPWTi treatment time and the hospitalization time of cured patients were counted.

Totally 45 patients were included, with 34 males and 11 females, aged 1.0- 82.0 years with an average age of (52.4 ± 16.2) years; 23 patients (51.11%) had a history of type 2 diabetes. According to the etiological classification, there were 13 cases of skin infection caused by furuncle and herpes zoster, 8 cases of pressure injury, 7 cases of trauma, 4 cases of diabetic foot, 4 cases of insect bite, 2 cases of infection after acupuncture, 1 case of infection after drug injection, 1 case of postoperative infection, 1 case of intestinal anastomotic fistula, 1 case of perianal abscess, and 3 cases of unknown etiology. According to the initial site of the wound, there were 21 cases of limbs, 13 cases of trunk, 6 cases of perineum and 5 cases of neck. Thirty-four patients had positive wound pathogen culture in 45 patients, in which 58 bacterial strain were cultivated, including 8 strains of Staphylococcus aureus, 8 strains of Enterococcus faecalis, 7 strains of Escherichia coli, 7 strains of Acinetobacter baumannii, 4 strains of Pseudomonas aeruginosa, 4 strains of Klebsiella pneumoniae, 1 strain of Candida albicans, and 19 strains of other bacteria. There were 23 cases (67.65%) of type-1 NSTI patients, 10 cases (29.41%) of type-2 NSTI in which 6 cases were Staphylococcus aureus infections and 4 cases were group A hemolytic streptococcal infections including 2 cases of Streptococcus pyogenes infection and 2 cases of Streptococcus constellations infection, and 1 case (2.94%) of type-4 NSTI which is Candida albicans infection. Among the 45 patients, 37 patients were cured, 5 patients left the hospital in advance after comprehensive sequential treatment, and 3 patients died (one of them died after being transferred to ICU), the hospital mortality was 6.67%. Two patients received amputation of the middle and lower leg, and 1 patient received toe amputation. Five patients received colostomy. The average operation times of cured patients was (4.2±2.0) times, the average NPWTi treatment time was (45.5 ± 31.7) d, and the average length of stay in hospital was (63.6 ± 39.5) d.

In this study, NSTI patients were mainly middle-aged and elderly people, and more men than women. Diabetes may be a risk factor for NSTI. The original wound sites were extremity, trunk, perinaeum and neck in turn. The most common pathogens mainly included Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, etc. NSTI patients with positive wound pathogens were mainly type 1 and type 2. The application of comprehensive sequential diagnosis and treatment strategy can play a good clinical effect on the treatment of NSTI.