Abstract
BackgroundNecrotizing fasciitis (NF) is a rare and life-threatening necrotizing skin and soft-tissue infection. Infectious pathogens of NF must be detected early and treated rapidly to prevent loss of limb or a fatal outcome. This study aimed to detect more reliable predictors between gram-negative and gram-positive monomicrobial NF of limbs.MethodsA total of 100 patients with limb monomicrobial NF were diagnosed prospectively from April 2015 to July 2018. These monomicrobial NF pathogens can be divided into gram-negative and gram-positive groups according to the result of Gram staining and final bacterial reports. Data such as demographics, seawater or seafood contact history, infectious location, comorbidities, presenting signs and symptoms, and laboratory findings were recorded and compared.ResultsA total of 55 patients were infected with gram-negative organisms and 45 patients with gram-positive organisms. Among the 55 cases of monomicrobial gram-negative NF, 48 (87.3%) were caused mainly by Vibrio spp. (38, 69.1%) and Aeromonas spp. (10, 18.2%). A higher incidence of chronic kidney disease, cerebrovascular accident, tachypnea, and septic shock; a higher rate of band forms of leukocytes of more than 3%, serum lactate of more than 20 mg/dL, and C-reactive protein level of less than 150 mg/dL; prolonged prothrombin time; and a lower fibrinogen level were observed in patients with gram-negative infection. In a multivariate analysis, a higher incidence of seawater or seafood contact history (odds ratio [OR]: 66.301; 95% confidence interval [CI]: 7.467–588.702), a higher rate of hyperlactatemia (OR: 7.904; 95% CI: 1.231–50.744), and a low fibrinogen level (OR: 1.013; 95% CI: 1.004–1.023) indicated gram-negative infection.ConclusionsIn southern Taiwan, NF of limbs mainly affected the lower limbs, exhibited monomicrobial infection, and was predominated by gram-negative bacteria. Gram-negative monomicrobial NF of limbs often occurred in individuals with the more seawater or seafood contact history, hyperlactatemia, and low fibrinogen levels.
Highlights
Necrotizing fasciitis (NF) is a rare and life-threatening necrotizing skin and soft-tissue infection
An appropriate antimicrobial regimen ordered with microbiologic proof, or empiric antimicrobial therapy supported by infectious-disease physicians should be performed in critically ill patients suffering from fulminant NF [13,14,15] to prevent loss of limb and even death
Patients with monomicrobial NF of limbs were enrolled in the study using the following criteria: (1) NF was defined by surgical findings, including the presence of grayish necrotic skin, subcutaneous fat and fascia, no resistance of normally adherent fascia to digital blunt dissection, and a purulent discharge resembling foulsmelling dishwater [8, 17, 24]; (2) Histopathological tissue specimens were obtained to confirm the diagnoses [3, 32]; (3) monomicrobial infection was documented by isolating single pathogenic bacteria from soft-tissue lesions and/or blood collected immediately after the patient’s arrival at the emergency department (ED) or during surgery [8, 17]; and (4) such bacteria infected any limb
Summary
Necrotizing fasciitis (NF) is a rare and life-threatening necrotizing skin and soft-tissue infection. An appropriate antimicrobial regimen ordered with microbiologic proof, or empiric antimicrobial therapy supported by infectious-disease physicians should be performed in critically ill patients suffering from fulminant NF [13,14,15] to prevent loss of limb and even death. “Vibrio NSSTIs Treatment and Research (VTR) Group,” at CGMH-Chiayi consists of professional medical staff working in various departments, namely, emergency medicine, orthopedic surgery, infectious diseases, intensive care unit, and hyperbaric oxygen treatment center. This group has conducted considerable research focused on comparing Vibrio vulnificus with other different infectious microorganisms, including Aeromonas spp. This group has conducted considerable research focused on comparing Vibrio vulnificus with other different infectious microorganisms, including Aeromonas spp. [13], Vibrio cholerae non-O1 [18], and Staphylococcus aureus (S. aureus) [22]
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