Abstract
IntroductionNecrotizing fasciitis (NF) is a life threatening infectious disease with a high mortality rate. We carried out a microbiological characterization of the causative pathogens. We investigated the correlation of mortality in NF with bloodstream infection and with the presence of co-morbidities.MethodsIn this retrospective study, we analyzed 323 patients who presented with necrotizing fasciitis at two different institutions. Bloodstream infection (BSI) was defined as a positive blood culture result. The patients were categorized as survivors and non-survivors. Eleven clinically important variables which were statistically significant by univariate analysis were selected for multivariate regression analysis and a stepwise logistic regression model was developed to determine the association between BSI and mortality.ResultsUnivariate logistic regression analysis showed that patients with hypotension, heart disease, liver disease, presence of Vibrio spp. in wound cultures, presence of fungus in wound cultures, and presence of Streptococcus group A, Aeromonas spp. or Vibrio spp. in blood cultures, had a significantly higher risk of in-hospital mortality. Our multivariate logistic regression analysis showed a higher risk of mortality in patients with pre-existing conditions like hypotension, heart disease, and liver disease. Multivariate logistic regression analysis also showed that presence of Vibrio spp in wound cultures, and presence of Streptococcus Group A in blood cultures were associated with a high risk of mortality while debridement > = 3 was associated with improved survival.ConclusionsMortality in patients with necrotizing fasciitis was significantly associated with the presence of Vibrio in wound cultures and Streptococcus group A in blood cultures.
Highlights
Necrotizing fasciitis (NF) is a life threatening infectious disease with a high mortality rate
We observed that 279 (86.4%) subjects were positive for growth of wound cultures, and 65 (20.1%) subjects were positive for growth of blood cultures (Table 1)
The presence of Vibrio spp in wound cultures, and the presence of Streptococcus group A in blood cultures increased the risk of mortality whereas patients with debridement > = 3 times had a lower risk of mortality (Table 7)
Summary
Necrotizing fasciitis (NF) is a life threatening infectious disease with a high mortality rate. We carried out a microbiological characterization of the causative pathogens. Understanding the mechanisms underlying the pathophysiology of an infectious disease and characterization of the causative organism are key to providing better medical or surgical care, preventing complications and initiating early, appropriate antimicrobial treatment. Necrotizing fasciitis (NF), a life-threatening infectious disease with mortality rate ranging from 17% to 34% [1,2,3,4,5,6] refers to a spectrum of diseases where necrosis of deeper soft tissue is driven by an infective microorganism [7]. It is most convenient to categorize NF based on the microbiological characteristics of the pathogen involved [12,13,14]. Necrotizing fasciitis caused by fungi was previously classified under Type 2, fungal necrotizing fasciitis has recently been classified under its own category [15]
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