Prediction and prevention of sepsis in patients with necrotizing fasciitis on the background of diabetes mellitus

Author(s):
Alisher Okhunov

Background:

Diagnosis and treatment of surgical infections remains one of the urgent problems of modern surgery. Evidence of this is the high mortality rate in severe forms of purulent-inflammatory diseases of soft tissues, which ranges from 28–56%, and with the development of sepsis – over 90%. Purulent-inflammatory diseases of soft tissues against the background of diabetes mellitus proceed atypically and rather aggressively. Those norms that are inherent in acute soft tissue infections without diabetes mellitus can have a contradictory effect on the fate of patients with concomitant diabetes mellitus.

Hypothesis:

To improve the results of treatment of patients with severe forms of purulent-inflammatory diseases of soft tissues against the background of diabetes mellitus by developing a prognosis and prevention of the generalization of the process.

Methods:

The results of treatment of 182 patients with necrotizing fasciitis associated with diabetes mellitus (93 patients in the control group, 89 patients in the main group) were analyzed. The mean age of the patients was 52.9±11.7 years. To predict the likelihood of sepsis (high, moderate, low), the following indicators were determined: pro-inflammatory cytokines (IL-1b, IL-6 and TNF-α), the presence of signs of SIRS, the area of prevalence of the purulent-inflammatory process, the level of microbial contamination of the wound with procalcitonin.

Results:

Based on the results of predicting the likelihood of developing sepsis, we developed an algorithm using a drug based on granulocyte colony-stimulating factor (Filgrastim). With a high likelihood of developing sepsis, Filgrastim was used by subcutaneous injection at a dose of 5 µg/kg of body weight for at least 5 days. With a moderate probability – Filgrastim was administered at a dose of 5 μg / kg of body weight for another 2 days. The drug was not used with a low probability.

Conclusions:

The use of Filgrastim on the basis of the diagnostic and treatment algorithm developed by us contributed to a decrease in the number of patients with sepsis on the 5th day of treatment compared with the control group of patients by 18.3 times. The effectiveness of the use of Filgrastim was also proven by the fact that among the patients of the main group on the 7th day of treatment there were no cases with a septic course of necrotizing fasciitis on the background of diabetes mellitus. The proportion of positive results in the main group of patients was higher by 11.3%, and mortality decreased by 4.5%