Treatment Outcome and Its Associated Factors among Patients Admitted with Necrotizing Soft Tissue Infection to Surgery Ward of Asella Referral and Teaching Hospital, Southeast Ethiopia

Abstract

Abstract Background: Necrotizing soft tissue infections are rapidly progressive, life-threatening surgical emergencies involving the fascia and subcutaneous tissues. They occur more commonly in males and are strongly associated with diabetes mellitus, immunodeficiency, obesity, malnutrition and other chronic illnesses. Despite advances in care, these infections carry high morbidity and mortality globally approaching 14–29% due to aggressive disease course. In Ethiopia, Necrotizing soft tissue infections are relatively common, especially in rural areas but data on their risk factors and outcomes remain scarce. Objective: To assess the treatment outcome and its associated factors among patients admitted to surgery ward with necrotizing soft tissue infection at Asella Referral and Teaching Hospital from January 2020 – July 2025. Methods: Institutional based cross sectional study was conducted among patients admitted with necrotizing soft tissue infection from January 2020 – July 2025. Data was extracted from patients’ medical record and registries using data extraction tools and entered in to Kobo-Toolbox then exported to SPSS Version 27 for analysis. All eligible cases that meet the inclusion criteria are included in the study during the study period. Descriptive statistics are used to describe the study variables. Bivariable logistic regression analysis is conducted to explore the crude association between each independent and dependent variable. Variables with P-value < 0.25 in the bivariable analysis are included in the multivariable logistic regression model to control for potential confounders and identify factors independently associated with treatment outcome. Adjusted odds ratio with its 95% CI at P-value <0.05 are used to report statistically significant association. Result: Out of 118 admitted patients, 96 patients fulfilled the inclusion criteria and were analyzed. Majority were males (67.7%) and rural residents (69.8%). Overall mortality was 17.7%. Nine variables were selected for inclusion in the multivariable logistic regression model. In the multivariable logistic regression analysis, abdominal site of infection involvement (AOR = 15.42; 95% CI: 1.46–162.61; p = 0.023), presence of shock (AOR = 24.57; 95% CI: 2.59–233.48; p =0.005), and acute kidney injury (AOR = 12.67; 95% CI: 1.58–101.57; p=0.017) were independently associated with poor treatment outcomes. Conclusion: The presence of septic shock at presentation and acute kidney injury significantly worsen treatment outcomes of necrotizing soft tissue infection. Early identification and referral with aggressive surgical intervention and intensive supportive care particularly for patients with abdominal involvement, shock and acute kidney injury are essential to improve treatment outcomes. Key words-Necrotizing soft tissue infection, Anemia, Acute kidney injury, Shock, Diabetes Mellitus