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Necrotizing fasciitis: is the bacterial spectrum changing?

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Abstract

Purpose

Necrotizing fasciitis (NF) is a rare, but potentially fatal pathology. The aim of the present study was to identify the population characteristics of the NF patients, the responsible bacteria, and the differences between survivors and nonsurvivors.

Methods

In this retrospective case–control study, all patients with NF from January 1, 2005, to December 31, 2010, treated in an academic level 1 trauma center, were identified, and their medical records were reviewed.

Results

The mortality rate of the 24 identified patients was 20.8 %. The majority of the infections (54.2 %) (13/24) were monomicrobial. Hemolytic Streptococcus of group A (25 %) and methicillin-resistant Staphylococcus aureus (20.8 %) were the commonest germs. The mean number of comorbidities was 3.62 (standard deviation (SD) 3.58). Diabetes mellitus, cardiovascular disease, and immunosuppression were the commonest. Mean number of operations was 8.1 (SD 4.7). Five patients (20.8 %) developed a disseminated intravascular coagulation (DIC); all of them died. Nonsurvivors, who presented with deteriorated coagulation factors, developed a DIC (p < 0.001) and received more often antibiotic monotherapy (ampicillin/sulbactam) as initial empirical therapy (p < 0.001).

Conclusions

The present study suggests a shift of the bacterial spectrum towards monomicrobial infections with multiresistant bacteria. The early recognition of high-risk patients and the aggressive surgical treatment with at least double-schema antibiotic therapy are of outmost importance.

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References

  1. Puvanendran R, Huey JC, Pasupathy S (2009) Necrotizing fasciitis. Can Fam Physician 55:981–987

    PubMed  Google Scholar 

  2. Descamps V, Aitken J, Lee MG (1994) Hippocrates on necrotising fasciitis. Lancet 344:556

    Article  PubMed  CAS  Google Scholar 

  3. Legbo JN, Shehu BB (2005) Necrotizing fasciitis: a comparative analysis of 56 cases. J Natl Med Assoc 97:1692–1697

    PubMed  Google Scholar 

  4. Frazee BW, Fee C, Lynn J, Wang R, Bostrom A, Hargis C, Moore P (2008) Community-acquired necrotizing soft tissue infections: a review of 122 cases presenting to a single emergency department over 12 years. J Emerg Med 34:139–146

    Article  PubMed  Google Scholar 

  5. Cainzos M, Gonzalez-Rodriguez FJ (2007) Necrotizing soft tissue infections. Curr Opin Crit Care 13:433–439

    Article  PubMed  Google Scholar 

  6. Ryssel H, Germann G, Kloeters O, Radu CA, Reichenberger M, Gazyakan E (2010) Necrotizing fasciitis of the extremities: 34 cases at a single centre over the past 5 years. Arch Orthop Trauma Surg 130:1515–1522

    Article  PubMed  Google Scholar 

  7. Lee TC, Carrick MM, Scott BG, Hodges JC, Pham HQ (2007) Incidence and clinical characteristics of methicillin-resistant Staphylococcus aureus necrotizing fasciitis in a large urban hospital. Am J Surg 194:809–812

    Article  PubMed  Google Scholar 

  8. Majeski J, Majeski E (1997) Necrotizing fasciitis: improved survival with early recognition by tissue biopsy and aggressive surgical treatment. South Med J 90:1065–1068

    Article  PubMed  CAS  Google Scholar 

  9. Gunter OL, Guillamondegui OD, May AK, Diaz JJ (2008) Outcome of necrotizing skin and soft tissue infections. Surg Infect (Larchmt) 9:443–450

    Article  Google Scholar 

  10. Endorf FW, Supple KG, Gamelli RL (2005) The evolving characteristics and care of necrotizing soft-tissue infections. Burns 31:269–273

    Article  PubMed  Google Scholar 

  11. Nisbet M, Ansell G, Lang S, Taylor S, Dzendrowskyj P, Holland D (2011) Necrotizing fasciitis: review of 82 cases in South Auckland. Intern Med J 41:543–548

    Article  PubMed  CAS  Google Scholar 

  12. Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO (2003) Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am 85-A:1454–1460

    PubMed  Google Scholar 

  13. Cuschieri J (2008) Necrotizing soft tissue infection. Surg Infect (Larchmt) 9:559–562

    Article  Google Scholar 

  14. Chapnick EK, Abter EI (1996) Necrotizing soft-tissue infections. Infect Dis Clin North Am 10:835–855

    Article  PubMed  CAS  Google Scholar 

  15. McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA (1995) Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 221:558–563, discussion 563–555

    Article  PubMed  CAS  Google Scholar 

  16. Moss RL, Musemeche CA, Kosloske AM (1996) Necrotizing fasciitis in children: prompt recognition and aggressive therapy improve survival. J Pediatr Surg 31:1142–1146

    Article  PubMed  CAS  Google Scholar 

  17. Headley AJ (2003) Necrotizing soft tissue infections: a primary care review. Am Fam Physician 68:323–328

    PubMed  Google Scholar 

  18. Callahan TE, Schecter WP, Horn JK (1998) Necrotizing soft tissue infection masquerading as cutaneous abcess following illicit drug injection. Arch Surg 133:812–817

    Article  PubMed  CAS  Google Scholar 

  19. Wall DB, de Virgilio C, Black S, Klein SR (2000) Objective criteria may assist in distinguishing necrotizing fasciitis from nonnecrotizing soft tissue infection. Am J Surg 179:17–21

    Article  PubMed  CAS  Google Scholar 

  20. Elliott DC, Kufera JA, Myers RA (1996) Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg 224:672–683

    Article  PubMed  CAS  Google Scholar 

  21. Kao LS, Knight MT, Lally KP, Mercer DW (2005) The impact of diabetes in patients with necrotizing soft tissue infections. Surg Infect (Larchmt) 6:427–438

    Article  Google Scholar 

  22. Wall DB, Klein SR, Black S, de Virgilio C (2000) A simple model to help distinguish necrotizing fasciitis from nonnecrotizing soft tissue infection. J Am Coll Surg 191:227–231

    Article  PubMed  CAS  Google Scholar 

  23. Barie PS (2004) The laboratory risk indicator for necrotizing fasciitis (LRINEC) score: useful tool or paralysis by analysis? Crit Care Med 32:1618–1619

    Article  PubMed  Google Scholar 

  24. Majeski JA, John JF Jr (2003) Necrotizing soft tissue infections: a guide to early diagnosis and initial therapy. South Med J 96:900–905

    Article  PubMed  Google Scholar 

  25. Urschel JD (1999) Necrotizing soft tissue infections. Postgrad Med J 75:645–649

    Article  PubMed  CAS  Google Scholar 

  26. Hong YC, Chou MH, Liu EH, Hsiao CT, Kuan JT, Lin JC, Chen IC (2009) The effect of prolonged ED stay on outcome in patients with necrotizing fasciitis. Am J Emerg Med 27:385–390

    Article  PubMed  Google Scholar 

  27. Boyer A, Vargas F, Coste F, Saubusse E, Castaing Y, Gbikpi-Benissan G, Hilbert G, Gruson D (2009) Influence of surgical treatment timing on mortality from necrotizing soft tissue infections requiring intensive care management. Intensive Care Med 35:847–853

    Article  PubMed  Google Scholar 

  28. Yilmazlar T, Ozturk E, Alsoy A, Ozguc H (2007) Necrotizing soft tissue infections: APACHE II score, dissemination, and survival. World J Surg 31:1858–1862

    Article  PubMed  Google Scholar 

  29. Khanna AK, Tiwary SK, Kumar P, Khanna R, Khanna A (2009) A case series describing 118 patients with lower limb necrotizing fasciitis. Int J Low Extrem Wounds 8:112–11

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Serafim Tsitsilonis, Claudia Druschel, Florian Wichlas, Norbert P. Haas, Philipp Schwabe & Klaus-Dieter Schaser

  2. Clinic for Traumatology and Orthopedics, Nuremberg Hospital South, Breslauer Str. 201, 90471, Nuremberg, Germany

    Hermann-Josef Bail

Authors
  1. Serafim Tsitsilonis
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  2. Claudia Druschel
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  3. Florian Wichlas
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  4. Norbert P. Haas
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  5. Philipp Schwabe
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  6. Hermann-Josef Bail
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  7. Klaus-Dieter Schaser
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Correspondence to Serafim Tsitsilonis.

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Tsitsilonis, S., Druschel, C., Wichlas, F. et al. Necrotizing fasciitis: is the bacterial spectrum changing?. Langenbecks Arch Surg 398, 153–159 (2013). https://doi.org/10.1007/s00423-012-0983-z

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  • DOI: https://doi.org/10.1007/s00423-012-0983-z

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