Alarming Microbiological and Clinical Profile of Soft Tissue Infections in Hilly Regions of Uttarakhand, India

Soft tissue infections have varying presentation ranging from cellulitis to life threatening necrotizing infections. They are often treated by primary care physicians and failure to recognize severe infections in time can influence eventual outcomes. The rising incidences of diabetes mellitus, smoking and alcoholism, coexistence of peripheral vascular disease and cold temperatures in hilly regions of Uttarakhand state of India make some of these infections life threatening. We studied 145 patients over a five year period treated on OPD and inpatient basis. We used the criteria suggested by IDSA, 2005, to identify potentially severe soft tissue infections, i.e. (1) pain disproportionate to the physical findings, (2) bullae, (3) cutaneous hemorrhage, (4) skin sloughing, (5) skin anesthesia, (6) rapid progression, and (7) gas in the tissues. Such patients were admitted to wards and received indoor treatment. Early fasciotomy and debridement, use of broad spectrum antibiotics and blood and nutritional support were considered important. The practice of using warm stones in rural areas, for hot fomentations or as counter irritants needs to be condemned. Such practices sometimes lead to severe soft tissue infections in tissues numbed by cold weather or compromised by diabetes or peripheral vasculopathy. Factors such as the offending organism, host immunity, strain of superadded infection, antibiotic resistance, local practices of wound management and diabetes etc. may influence the eventual outcome. Failure to improve should raise the suspicion of resistant infections like MRSA, and such patients should receive indoor treatment to allow patients to receive instensive care and organ support when needed.