Abstract
Necrotizing fasciitis (NF) of the limbs caused by Aeromonas species is an extremely rare and life-threatening skin and soft tissue infection. The purpose of this study was to evaluate the specific characteristics and the independent predictors of mortality in patients with Aeromonas NF. Sixty-eight patients were retrospectively reviewed over an 18-year period. Differences in mortality, demographics data, comorbidities, symptoms and signs, laboratory findings, microbiological analysis, empiric antibiotics treatment and clinical outcomes were compared between the non-survival and the survival groups. Twenty patients died with the mortality rate of 29.4%. The non-survival group revealed significant differences in bacteremia, monomicrobial infection, cephalosporins resistance, initial ineffective empiric antibiotics usage, chronic kidney disease, chronic hepatic dysfunction, tachypnea, shock, hemorrhagic bullae, skin necrosis, leukopenia, band polymorphonuclear neutrophils >10%, anemia, and thrombocytopenia. The multivariate analysis identified four variables predicting mortality: bloodstream infection, shock, skin necrosis, and initial ineffective empirical antimicrobial usage against Aeromonas. NF caused by Aeromonas spp. revealed high mortality rates, even through aggressive surgical debridement and antibacterial therapies. Identifying those independent predictors, such as bacteremia, shock, progressive skin necrosis, monomicrobial infection, and application of the effective antimicrobial agents against Aeromonas under the supervision of infectious doctors, may improve clinical outcomes.
Highlights
Necrotizing fasciitis (NF) is a rare and life-threatening necrotizing soft tissue infection (NSSTI) characterized by a rapid bacterial spread with soft tissue necrosis in the subcutaneous layers, within superficial and deep fascia, with overall mortality rates of 12.1–76%1–8
We set up the team “Vibrio NSSTIs Treatment and Research (VTR) Group”, which consists of professional staff working in various departments, including emergency medicine, orthopedic surgery, infectious diseases, intensive care unit (ICU), and hyperbaric oxygen treatment center
No significant differences were observed within the parameters of age, gender, infective regions, or the number of amputations per patient between these two groups
Summary
Necrotizing fasciitis (NF) is a rare and life-threatening necrotizing soft tissue infection (NSSTI) characterized by a rapid bacterial spread with soft tissue necrosis in the subcutaneous layers, within superficial and deep fascia, with overall mortality rates of 12.1–76%1–8. An appropriate empiric antimicrobial therapy supported by physicians specialized in infectious disease, and aggressive intensive unit care should be initially administered in critically ill patients suffering from fulminant NF to prevent limb loss and possible death[9,10,11]. We set up the team “Vibrio NSSTIs Treatment and Research (VTR) Group”, which consists of professional staff working in various departments, including emergency medicine, orthopedic surgery, infectious diseases, intensive care unit (ICU), and hyperbaric oxygen treatment center. We have established a treatment strategy including emergency fasciotomy or amputation, antibiotic therapy with a third-generation cephalosporin plus tetracycline, and admission to the ICU for patients suspected. There are more than 20 Aeromonas species identified, but only seven have been recognized as human pathogens, namely, A. hydrophila, A. caviae, A. veronii biovar sobria, A. veronii biovar veronii, A. jandaei, A. trota, and A. schubertii, with the first three being the most common causes of NF24,29 The aim of this study was to evaluate the specific characteristics and the independent predictors of mortality in patients with Aeromonas NF, and to gain insight and improve future outcomes
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