A Report for the preparation of thesis to be Submitted to College of Public Health and Medical Sciences and Department of Surgery, Jimma University, in partial fulfillment of the requirement for a Specialty Certificate in Surgery.

Abstract

Introduction Necrotizing bacterial infections are extremely serious, fulminant infections of the soft tissues by virulent bacteria. The annual incidence of NF is estimated at 500–1,000 cases annually, and its prevalence globally has been reported to be 0.40 cases per 100,000 populations. It is seen to have a predilection for men, with a male-to-female ratio of 3:1. The disease affects all age groups.Clinical risk factors for necrotizing soft-tissue infection include diabetes mellitus, malnutrition, obesity, chronic alcoholism, peripheral vascular disease , steroid use, cirrhosis, and autoimmune deficiency syndrome .The mortality associated with NSTI has been in the range of 16% to 45%. Necrotizing fasciitis is uncommon in Ethiopia but the prevalence and risk factor patterns of the disease in Ethiopia setup have not been well studied. Methods A retrospective cross-sectional review of medical records of patients who developed necrotizing fasciitis during the period between January 1, 2011 – December 31, 2015 in Jimma University specialized hospital. Patient demographics, presentation, microbiology, treatment, and outcome were recorded. Data analyzed by description of major variables, and comparison of relationships among variables using computer (SPSS software program). Chi-square and p-value used to determine association between variables and p-value<0.05 considered significant. Results Overall, 78 patients were diagnosed with necrotizing fasciitis and mortality rate is 19.23 % (n=15). The prevalence of necrotizing fasciitis in this study is 0.52/100000 population. The mean age of patients was 36.33years (range: 37 days to 80 years). Male s affected in 70.5 % (n=55) and female affected in 29.5% (n=23). There were no obvious predisposing factors in 75.7 % (n=59) cases. From all the patients 15.4% had (n=12) had significant co morbidities. The most common site affected is lower limb (39.7%, n=31) and the next common is perineum (34.6%, n=27). The most common infection site in male was perineum account all this site infection. The median duration of hospital stay was 25.5 days. Conclusion This study showed a low prevalence of necrotizing fasciitis infection with a mortality rate of 19.23%. Diabetes mellitus, RVI and malnutrition were identified as the main co-morbidities. The findings of our study are somewhat limited in their application to other regions and highlight the need for a national analysis of necrotizing fasciitis in the Ethiopia. It is important to have Prospective studies to examine the fitness and sufficiency of these variables as effective predictors of NF mortality.