Fasciites nécrosantes chez les patients diabétiques : Ã propos de 14 cas

Necrotizing fasciitis (NF) is an infection of the subcutaneous cellular tissue reaching the superficial fascia. The objective of the work is to report cases of FN in our context as well as their management. We report 14 cases of NF over a period of 4 years. The aim of our report was to describe their clinical, bacteriological characteristics and their therapeutic management: Average age 46.7 years, predominantly male, 11 T2DM and 3 T1DM patients with poor glycemic control. NF was localized on the lower limb in 11 patients, 3 patients had other localizations. Bacteriological sampling was in favour of haemolytic streptococcus group A in 12 patients and Staphylococcus aureus in 2 patients. The initial management is based on daily local care and probabilistic antibiotherapy with amoxicillin-clavulanic acid, then adapted to the antibiogram. The initial evolution was marked by a local worsening in all patients with onset of systemic symptoms in 12/14 patients. Further management is based on surgery with the removal of necrotic tissue of superficial fascia in all patients associated with appropriate antibiotics and local treatment. The final evolution was a local and general improvement in 12 patients who received a graft, the death of one patient due to sepsis, and amputation of the foot in a patient seen with a late referral. We conclude that, in our context, the early diagnosis of NF with the clinical assessment of skin lesions, medical and surgical treatments may improve survival and functional prognosis.