Synchronous multifocal necrotizing fasciitis prognostic factors: a retrospective case series study in a single center.

Ching-Yu Lee,Wei-Hsiu Hsu,Kuo-Chin Huang,Yen-Yao Li,Yao-Hung Tsai,Tsan-Wen Huang,Tsung-Yu Huang,Jou-Chen Huang

doi:10.1007/s15010-016-0932-9

Abstract

PurposeNo reports have been published on synchronous multifocal necrotizing fasciitis (SMNF), a multifocal presence of necrotizing fasciitis in different extremities. We evaluated the clinical characteristics and outcomes of SMNF.MethodsEighteen patients (14 men, 4 women; mean age: 59 years) diagnosed with SMNF of the extremities between January 2004 to December 2012 were enrolled and evaluated.Results Vibrio species were the most commonly (78%; n = 14) isolated; others were two cases (11%) of Aeromonas spp., one case (6%) of group A β-hemolytic streptococcus, and one case of coagulase-negative staphylococcus. SMNF was in the bilateral lower limbs (72%; n = 13), bilateral upper limbs (17%; n = 3), and one patient with one upper and one lower limb (11%). Non-surviving patients had more bilateral lower limb involvement and thrombocytopenia.ConclusionsMost patients with SMNF were male and had bilateral lower limb and marine Gram-negative bacteria involvement. The mortality of SMNF remained extremely high in patients with involvement of bilateral lower limb and initial thrombocytopenia.

Highlights

Necrotizing fasciitis (NF) is an uncommon deep soft tissue infection characterized by a rapidly spreading necrosis of superficial fascia and subcutaneous tissue [1]
Twelve patients with synchronous multifocal necrotizing fasciitis (SMNF) died: ten patients died of the uncontrolled original infection, one patient died of complicated pneumonia and a fungal urinary tract infection with fungemia, and one patient died of comorbidities [liver cirrhosis (Child-Pugh Class C) and upper gastrointestinal bleeding] within 4 months after hospital discharge
There was no significant difference in bacterial species between the groups (Table 5). This is the first report of a case series of SMNF and analysis of its predictive factors for mortality

Summary

Introduction

Necrotizing fasciitis (NF) is an uncommon deep soft tissue infection characterized by a rapidly spreading necrosis of superficial fascia and subcutaneous tissue [1]. Typical NF involves primarily a single site, some recent studies report the concurrent involvement of multiple sites [2,3,4]. Some reports [2, 5, 6] incidentally indicate that multifocal necrotizing fasciitis leads to a higher mortality rate than does monofocal NF. We found no reports that focused primarily on synchronous multifocal necrotizing fasciitis (SMNF). We evaluated the clinical characteristics and outcomes of SMNF

Methods

Results

Conclusion