Author(s)

Jean Claude Niyondiko^1*, Evrard Niyonkuru², Gilbert Ndayizeye¹, Stève Nimubona¹, Clovis Paulin Baramburiye², Léodégal Bazira²

¹Kamenge Teaching Hospital, Department of Trauma and Orthopedic Surgery, Bujumbura, Burundi.
²Kamenge Teaching Hospital, Department of General Surgery, Bujumbura, Burundi.

Background: Necrotizing fasciitis is a rapidly spreading soft tissue infection involving the deep facial layers. It can cause secondary necrosis leading to significant morbidity and mortality. The most important predictor of mortality is a delay in diagnosis. In low income countries, that delay must be high and other predictors of morbidity and mortality must be pointed out. Objective: To determine necrotizing fasciitis (NF) prognostic factors in a low income country. Patients and Methods: It is a prospective and descriptive study conducted over a one-year period from November 1, 2017 to November 1, 2018 about 23 cases of necrotizing fasciitis in two hospitals of Bujumbura. Results: The incidence of necrotizing fasciitis in these 2 hospitals (Kamenge Teaching Hospital and Prince Regent Charles Hospital) was 1%. The average age of patients was 41.76 years. Males were predominant with a sex ratio of 1.55. The risk factors for NF were: NSAIDs in 39%; HIV infection in 13%, diabetes mellitus in 4% and high blood pressure in 4%. The average time from symptoms onset to admission was 17.13 days. The mean time from admission to surgical treatment was 4 days with extremes of 1 to 22 days. The most affected site was the lower limb in 82% of cases. All patients (96%) were treated with necrotic tissue debridement. It was associated with skin grafting in 48% of cases. One patient (4%) with diabetes mellitus and HIV infection was amputated. The mortality rate was 22% (n = 5). Among those 5 patients, there was a combination of risk factors (diabetes mellitus, NSAID use and HIV infection) in 80% (n = 4), 60% (n = 3) were over 60 years of age and 60% (n = 3) were operated 10 days after the onset of symptoms. The average time of hospital stay was 101 days with extremes of 14 to 400 days. Conclusion: Necrotizing fasciitis is associated with a high mortality rate in low income countries. The use of NSAIDs; delayed treatment, elderly and immunosuppressive conditions such as diabetes mellitus and HIV are the most prognostic factors in Bujumbura hospitals.

Necrotizing Fasciitis, Prognosis, Low Income Countries

Niyondiko, J. , Niyonkuru, E. , Ndayizeye, G. , Nimubona, S. , Baramburiye, C. and Bazira, L. (2021) Necrotizing Fasciitis in Low Income Countries: About 23 Cases of Bujumbura Hospitals. Open Journal of Orthopedics, 11, 33-39. doi: 10.4236/ojo.2021.112004.