An Audit on risk factors, spectrum of the disease and outcome of soft tissue infections

Abstract

Soft tissue infections are a common clinical entity in surgical practice. There are recognized local, regional and systemic risk factors documented in literature with a vast spectrum of presentation. Failure of early treatment could lead to adverse outcomes. There is a minimal number of studies and local data available. This is a descriptive cross-sectional study which was conducted on 53 consecutive patients in Teaching Hospital Peradeniya to describe the risk factors, anatomical site, treatment and the outcome of soft tissue infections. Study population consisted of 30 males and 23 females in the age range of 22 years to 90 years, where 69.8% were above 50 years of age. Cellulitis (54.7%), abscesses (37.7%) and gangrene (13.2%) were the commonest presentations. Surprisingly, the majority had no preceding obvious injury (62.2%), while 30.1% reported a traumatic event. A significant number (80.3%) of the population presented with lower limb soft tissue infections. Diabetes mellitus (41.5%), hypertension (20.8%) and dyslipidaemia (11.3%) were the three main comorbidities identified. 52.8% had scars, 39.6% had an active ulcer and 33.9% had cracked feet which may have contributed. Within the blood investigations 67.9% of patients had increased white cell counts but 77.4% had elevated C-reactive protein levels. Almost all the patients (98.1%) had received antibiotics, mostly in IV route (90.4%). As per surgical management, surgical debridement (28.3%) and incision and drainage (20.75%) were commonly utilized. Out of the study population only 42.5% completely recovered and 51% end up with poor healing ulcers. One patient needed an amputation (2.1%). Therefore, elderly populations with multiple comorbidities are at high risk of developing lower limb soft tissue infections and end up having poor outcomes, despite medical and surgical management.