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Necrotizing fasciitis, causative agents and management: a five-year retrospective study in two tertiary care hospitals in Central Malaysia

International Orthopaedics volume 45, pages 1399–1405 (2021)Cite this article

Abstract

Purpose

Necrotizing fasciitis (NF) is a rapidly progressive inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues. The severity of the disease depends on the virulence of the organism and host immunity. There is a paucity of reports on the prevalence of NF causing pathogens and management.

Methods

Retrospective data of patients treated for NF were collected from two tertiary care hospitals in Central Malaysia between January 2014 and December 2018.

Results

A total of 469 NF patients were identified. More than half of the NF patients were males (n = 278; 59.28%). The highest number of cases was found among age groups between 30 and 79, with mean age of 56.17. The majority of the NF cases (n = 402; 85.72%) were monomicrobial. Streptococcus spp. (n = 89; 18.98%), Pseudomonas aeruginosa (n = 63; 13.44%) and Staphylococcus spp. (n = 61; 13.01%) were identified as the top three microorganisms isolated. Among the 469 NF cases, 173 (36.8%) were amputated or dead while 296 (63.1%) recovered. Proteus spp. (n = 19; 12.93%), Klebsiella pneumoniae (n = 18; 12.24%) and Escherichia coli (n = 14; 9.52%) were associated with all types of amputations. The most common antibiotic prescribed was unasyn (n = 284; 60.56%), followed by clindamycin (n = 56; 11.94%) and ceftazidime (n = 41; 8.74%). A total of 239 (61.8%) recovered while 148 (38.2%) were either amputated or dead when managed with the unasyn, clindamycin or ceftazidime.

Conclusion

This study represents the largest NF cases series in Malaysia highlighting the causative agents and management.

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Acknowledgements

We would like to acknowledge our gratitude to the Head of Department of Orthopaedics, Hospital Tuanku Jaafar Seremban and Hospital Ampang for their cooperation and support in this study.

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Authors and Affiliations

  1. Department of Orthopaedic, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia

    Sanjiv Rampal, Rubenandran Ramachandran, Eng Kee Tan & Mohd Asyraf Hafizuddin Ab Halim

  2. Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia

    Sandra Maniam

  3. Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia

    Poh Ying Lim

  4. Orthopaedic Department, Hospital Tuanku Ja’afar, Jalan Rasah, Bukit Rasah, 70300, Seremban, Negeri Sembilan, Malaysia

    Zulfahrizzat Shamsudin

  5. Orthopaedic Department, Hospital Ampang, Jalan Mewah Utara, Pandan Mewah, 68000, Ampang, Selangor Darul Ehsan, Malaysia

    Sandeep Singh Sarawan Singh

  6. Department of Internal Medicine, Hospital Sarikei, Jalan Rentap, 96100, Sarikei, Sarawak, Malaysia

    Pravind Narayanan

  7. Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia

    Vasantha Kumari Neela

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  1. Sanjiv Rampal
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  2. Sandra Maniam
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Contributions

Conceptualization, SR and VKN; methodology, SR and VKN; software, LPY; validation, SR and VKN; formal analysis, LPY; investigation, RR, TEK, MAHAH, ZS, SSSS.; resources, RR, TEK, MAHAH, ZS, SSSS; data curation, LPY; writing—original draft preparation, SM, RN, VKN and SR; writing—review and editing, SM, RR, VKN and SR.; visualization, SR and VKN; supervision, SR; project administration. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Vasantha Kumari Neela.

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This is a retrospective study; hence, no consent was obtained from subjects; however, the study was conducted after approval from the ethics committee.

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Rampal, S., Maniam, S., Lim, P.Y. et al. Necrotizing fasciitis, causative agents and management: a five-year retrospective study in two tertiary care hospitals in Central Malaysia. International Orthopaedics (SICOT) 45, 1399–1405 (2021). https://doi.org/10.1007/s00264-020-04905-2

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  • DOI: https://doi.org/10.1007/s00264-020-04905-2

Keywords

  • Necrotizing fasciitis
  • Malaysia
  • Streptococcus spp.
  • Pseudomonas aeruginosa
  • Staphylococcus spp.
  • Unasyn