Objective
Necrotizing fasciitis (NF) is a life-threatening soft tissue infection resulting in extensive necrosis and gangrene. This study aimed to investigate the clinical characteristics and outcome of NF patients before and after implementation of a standardized management protocol.
Materials and Methods
We reviewed NF patients between 2005 and 2018 treated at a university hospital in Taiwan before and after implementation of a NF management protocol in 2012 (2005–2011 vs. 2013–2018).The Protocol is to promote the multidisciplinary intensive care, use of unified and board-spectrum empirical antibiotic regimen, early surgical intervention, and daily wound inspection with efficiency and efficacy. The main outcome was day 28-censored in-hospital mortality.
Results
Total 159 patients were included in this study. There were 69 patients admitted before the protocol implementation, and 84 patients admitted after the protocol implementation. More patients presented with pain (78.3% vs 90.5%, p=0.036), erythema (66.7% vs 82.1%, p= 0.028) and less patient with hypotension (42% vs 21.4%, p=0.0062) and C-reactive protein (CRP) level more than 15mg/dl (55.1% vs 79.4%, p=0.0325) noted in in the group after protocol implementation. Moreover, the 28-day mortality rate was lower after protocol implementation(36.2% vs 11.0%, p=0.0004). In the multivariate analysis of the risk factors of NF mortality, neutropenia as initial presentation was the only risk factor of 28 day-mortality (HR:6.48, 1.74-25.2, p=0.0054), while initial presentation with erythema (HR: 0.41 (0.19-0.9), p=0.0267) and protocol implementation seemed to be the protective factor of 28 day-survival in (HR:0.33 (0.14-0.75), p=0.0079)
Conclusions
In our study, the protocol implementation seemed to improve the survival of patient with NF.

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