1980 - Catheter related necrotizing fascitiis in haematological patients. Case report and implications for nursing

Background

Necrotizing fasciitis (NF) is a live-treating acute skin infection of soft tissues and muscles, extended from a trivial skin lesion, with rapid progression to necrosis. It is relatively uncommon and has a high mortality rate (∼32.2%) approaching 100% without treatment. Most cases present an anaerobic bacterium that produce gas, accumulated in the soft tissue spaces giving the characteristic image of gas gangrene on X rays (1). Site inspection reveals inflammation, oedema, and discoloration or gangrene and anaesthesia. A distinguishing clinical feature is the induration of the subcutaneous tissues (2). Early diagnosis is mandatory. Delay is associated with more extensive surgery and higher rates of amputation and mortality (1). Therapy includes radical surgical debridement with empirical broad-spectrum antibiotic coverage (2,3). Immunosuppressed patients or suffering from haematological malignancies are particularly at risk presenting an atypical etiopathology (3).

Methods

Two cases were retrospectively reviewed through medical history records to determine possible nursing implications to prevent or detect earlier cases in the future.

Results

Patient A: 53 year old woman being treated for Acute Myeloid Leukaemia (AML) with grade 4 neutropenia. She referred pain in her catheter site and presented fever and hypotension. After some days NF was diagnosed requiring 3 surgical interventions. Pseudomonas Aeruginosa was isolated in blood cultures. Patient B: 71 year old woman under treatment for AML with grade 3 neutropenia. NF in her Peripheral Insertion Central Catheter site was diagnosed. She presented no symthoms the days before but fever in the diagnosis. She required 2 surgical interventions. Klebsiella oxytoca and Enterobacter cloacae were isolated in blood cultures. Intensive care admission and longer hospitalization was required in both cases. NF was controlled but they had long term consequences (loss of mobility, paresthesia or pain).

Conclusions

FN is a rare potentially lethal infection in neutropenic patients. Oncology Nurses must be aware of this complication and patient implications in order to detect it earlier. Prompt diagnosis is crucial to prevent major surgical trauma, mortality and long-term morbidity.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Hosptial Clínic de Barcelona.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.