1
|
Lee BH, Leong YH, Kwek Beng Kee E. Atypical Presentation of Klebsiella pneumoniae Necrotizing Fasciitis of the Lower Extremities: Silent but Deadly: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00082. [PMID: 37708317 DOI: 10.2106/jbjs.cc.23.00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
CASE There has been an emerging trend of Klebsiella pneumoniae necrotizing fasciitis (KP-NF). We report a 50-year-old Chinese woman with rapidly progressive KP-NF, presenting atypically with innocuous skin symptoms. She had newly diagnosed diabetes mellitus. She had extensive subcutaneous crepitus in her lower limbs with subcutaneous gas on x-rays. Despite aggressive surgical debridement, she succumbed to septic shock and multiorgan failure. CONCLUSION KP-NF is an emerging clinical entity and is associated with a compromised host immunity and high mortality rates. Clinicians must be aware that not all may present with the typical fulminant features and should maintain a high index of suspicion.
Collapse
Affiliation(s)
- Bing Howe Lee
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
| | - Yen Hsin Leong
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
| | | |
Collapse
|
2
|
Gram-Negative Endogenous Endophthalmitis: A Systematic Review. Microorganisms 2022; 11:microorganisms11010080. [PMID: 36677371 PMCID: PMC9860988 DOI: 10.3390/microorganisms11010080] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/20/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Gram-negative bacteria are causative agents of endogenous endophthalmitis (EBE). We aim to systematically review the current literature to assess the aetiologies, risk factors, and early ocular lesions in cases of Gram-negative EBE. Methods: All peer-reviewed articles between January 2002 and August 2022 regarding Gram-negative EBE were included. We conducted a literature search on PubMed and Cochrane Controlled Trials. Results: A total of 115 studies and 591 patients were included, prevalently Asian (98; 81.7%) and male (302; 62.9%). The most common comorbidity was diabetes (231; 55%). The main aetiologies were Klebsiella pneumoniae (510; 66.1%), Pseudomonas aeruginosa (111; 14.4%), and Escherichia coli (60; 7.8%). Liver abscesses (266; 54.5%) were the predominant source of infection. The most frequent ocular lesions were vitreal opacity (134; 49.6%) and hypopyon (95; 35.2%). Ceftriaxone (76; 30.9%), fluoroquinolones (14; 14.4%), and ceftazidime (213; 78.0%) were the most widely used as systemic, topical, and intravitreal anti-Gram-negative agents, respectively. The most reported surgical approaches were vitrectomy (130; 24.1%) and evisceration/exenteration (60; 11.1%). Frequently, visual acuity at discharge was no light perception (301; 55.2%). Conclusions: Gram-negative EBEs are associated with poor outcomes. Our systematic review is mainly based on case reports and case series with significant heterogeneity. The main strength is the large sample spanning over 20 years. Our findings underscore the importance of considering ocular involvement in Gram-negative infections.
Collapse
|
3
|
Haen P, Laversanne S, Graillon N, Foletti JM. Facial necrotising fasciitis following rhytidectomy. Br J Oral Maxillofac Surg 2019; 57:685-687. [PMID: 31204188 DOI: 10.1016/j.bjoms.2019.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/28/2019] [Indexed: 11/24/2022]
Abstract
Rhytidectomy is the most common surgical procedure used to rejuvenate the appearance of the aging face and neck. Necrotising fasciitis is a rapidly progressing, life-threatening, bacterial infection of the skin, the subcutaneous tissue, and the fascia. We report a case of necrotising fasciitis of the face caused by a group A streptococcal infection after rhytidectomy on a healthy female patient. An abscess on her hand that had been caused by an infection related to a venous catheter had provided a potential entry for the pathogen, and treatment combined both surgical debridement and antibiotics. The operation had resulted in large tissue losses around the ears, which we treated by healing by second intention.
Collapse
Affiliation(s)
- P Haen
- Department of Oral and Maxillofacial Surgery, Hôpital d'Instruction des Armées Laveran, Boulevard Laveran, 13013 Marseille, France.
| | - S Laversanne
- Department of Oral and Maxillofacial Surgery, Hôpital d'Instruction des Armées Laveran, Boulevard Laveran, 13013 Marseille, France
| | - N Graillon
- Department of Oral and Maxillofacial Surgery, Assistance Publique des Hôpitaux de Marseille, Hôpital de la Conception, Boulevard Baille, 13005 Marseille, France
| | - J M Foletti
- Department of Oral and Maxillofacial Surgery, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Chemin des Bourrely, 13326 Marseille, France
| |
Collapse
|
4
|
A Patient With Periorbital Necrotizing Fasciitis by Klebsiella pneumoniae. J Craniofac Surg 2019; 30:e245-e247. [DOI: 10.1097/scs.0000000000005199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
5
|
Rahim G, Gupta N, Maheshwari P, Singh M. Monomicrobial Klebsiella pneumoniae necrotizing fasciitis: an emerging life-threatening entity. Clin Microbiol Infect 2019; 25:316-323. [DOI: 10.1016/j.cmi.2018.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/05/2018] [Accepted: 05/12/2018] [Indexed: 10/16/2022]
|
6
|
Chiu HHC, Francisco CN, Bruno R, Jorge Ii M, Salvaña EM. Hypermucoviscous capsular 1 (K1) serotype Klebsiella pneumoniae necrotising fasciitis and metastatic endophthalmitis. BMJ Case Rep 2018; 11:11/1/e226096. [PMID: 30567095 DOI: 10.1136/bcr-2018-226096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A 48-year-old man presented with a non-healing wound on his left foot after stepping on a nail. He self-medicated with amoxicillin, but the wound progressed prompting consult. On examination, his left foot was diffusely swollen with surrounding erythema, areas of gangrene, foul-smelling purulent discharge and subcutaneous emphysema. He was managed as a case of necrotising fasciitis and underwent emergent amputation. Three days after amputation, he developed a sudden and progressive blurring of vision, swelling and conjunctival erythema, with purulent discharge and the presence of hypopyon on the left eye. He was then managed as a case of endophthalmitis of the left eye and underwent pars plana vitrectomy. All cultures (blood, tissue and vitreous fluid) grew pan-susceptible hypermucoviscous Klebsiella pneumoniae, with positive string tests and confirmed by multilocus gene sequencing and sequence type analysis. He gradually improved with intravenous antibiotics, but only regained light perception in the left eye.
Collapse
Affiliation(s)
- Harold Henrison Chang Chiu
- Department of Medicine, College of Medicine & Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Christian Nadonga Francisco
- Section of Infectious Diseases, Department of Medicine, College of Medicine & Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Racquel Bruno
- Department of Medicine, College of Medicine & Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Manuel Jorge Ii
- Department of Medicine, College of Medicine & Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Edsel Maurice Salvaña
- Section of Infectious Diseases, Department of Medicine, College of Medicine & Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| |
Collapse
|
7
|
Persichino J, Kim D, Lee H, Sutjita M. Eight cases of invasive Klebsiella pneumoniae infection from a public teaching medical institution in the USA. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jon Persichino
- Department of Internal Medicine, Riverside County Regional Medical Center, Moreno Valley, CA, USA
| | - Daniel Kim
- Department of Internal Medicine, Riverside County Regional Medical Center, Moreno Valley, CA, USA
| | - Hayley Lee
- Office of Research, Riverside County Regional Medical Center, Moreno Valley, CA, USA
| | - Made Sutjita
- Infectious Disease Section, Riverside County Regional Medical Center, Moreno Valley, CA, USA
| |
Collapse
|
8
|
Abstract
Necrotizing fasciitis (NF) is an uncommon infection, but potentially lethal, especially when associated with systemic disorders such as diabetes. The authors report a case of necrotizing fasciitis from odontogenic origin in a patient with uncontrolled diabetes mellitus. The initial diagnosis was based on clinical information, in which multiple necrosis areas in cervical and thoracic regions were observed. Wide antibiotic therapy was applied, followed by surgical drain age and debridement. Culture was positive for methicillin-resistant Staphylococcus aureus. Although the treatment is established, the patient dies after sepsis and failure of vital organs. Clearly, the morbidity associated to this infection, even in diabetic patients, can be minimized if an early diagnosis and effective debridement are done.
Collapse
|
9
|
Ng D, Frazee B. Necrotizing fasciitis caused by hypermucoviscous Klebsiella pneumoniae in a Filipino female in North America. West J Emerg Med 2014; 16:165-8. [PMID: 25671032 PMCID: PMC4307707 DOI: 10.5811/westjem.2014.11.23599] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/07/2014] [Accepted: 11/11/2014] [Indexed: 11/21/2022] Open
Abstract
Necrotizing fasciitis caused by Klebsiella pneumoniae has been described in Southeast Asia, but has only recently begun to emerge in North America. The hypermucoviscous strain of K. pneumoniae is a particularly virulent strain known to cause devastatingly invasive infections, including necrotizing fasciitis. Here we present the first known case of necrotizing fasciitis caused by hypermucoviscous K. pneumoniae in North America.
Collapse
Affiliation(s)
- Daniel Ng
- Highland Hospital - Alameda Health System, Department of Emergency Medicine, Oakland, California
| | - Brad Frazee
- Highland Hospital - Alameda Health System, Department of Emergency Medicine, Oakland, California
| |
Collapse
|
10
|
Monié M, Drieux L, Nzili B, Dicko M, Goursot C, Greffard S, Decré D, Mézière A. Klebsiella pneumoniae necrotizing fasciitis of the leg in an elderly French woman. Clin Interv Aging 2014; 9:1171-4. [PMID: 25071368 PMCID: PMC4111645 DOI: 10.2147/cia.s60812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Klebsiella pneumoniae necrotizing fasciitis is a rare infection in regions outside of Asia. Here, we present a case of necrotizing fasciitis of the leg caused by K. pneumoniae in a 92-year-old French woman hospitalized in a geriatric rehabilitation unit. The patient initially presented with dermohypodermitis of the leg that developed from a dirty wound following a fall. A few hours later, this painful injury extended to the entire lower limb, with purplish discoloration of the skin, bullae, and necrosis. Septic shock rapidly appeared and the patient died 9 hours after the onset of symptoms. The patient was Caucasian, with no history of travel to Asia or any underlying disease. Computed tomography revealed no infectious metastatic loci. Blood cultures showed growth of capsular serotype K2 K. pneumoniae strains with virulence factors RmpA, yersiniabactin and aerobactin. This rare and fatal case of necrotizing fasciitis caused by a virulent strain of K. pneumoniae occurred in a hospitalized elderly woman without risk factors. Clinicians and geriatricians in particular should be aware of this important albeit unusual differential diagnosis.
Collapse
Affiliation(s)
- Marguerite Monié
- Assistance Publique-Hôpitaux de Paris (AP-HP), GHU Pitié Salpêtrière-Charles Foix, site Charles Foix, Service de Soins de Suite et Réadaptation orthogériatrique et polyvalent, Fondation d’Heur et Chemin Delatour, Ivry s/Seine, Paris, France
| | - Laurence Drieux
- Assistance Publique-Hôpitaux de Paris, Hôpital Charles-Foix, Bactériologie-Hygiène, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d’Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France
- INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France
| | - Bernadette Nzili
- Assistance Publique-Hôpitaux de Paris (AP-HP), GHU Pitié Salpêtrière-Charles Foix, site Charles Foix, Service de Soins de Suite et Réadaptation orthogériatrique et polyvalent, Fondation d’Heur et Chemin Delatour, Ivry s/Seine, Paris, France
| | - Michèle Dicko
- AP-HP, GHU Henri Mondor, Département de Médecine Interne et Gériatrie, Créteil, France
| | - Catherine Goursot
- Assistance Publique-Hôpitaux de Paris (AP-HP), GHU Pitié Salpêtrière-Charles Foix, site Charles Foix, Service de Soins de Suite et Réadaptation orthogériatrique et polyvalent, Fondation d’Heur et Chemin Delatour, Ivry s/Seine, Paris, France
| | - Sandrine Greffard
- AP-HP, GHU Pitié Salpêtrière-Charles Foix, site Pitié Salpêtrière, Service de Médecine Gériatrique, Paris, France
| | - Dominique Decré
- Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d’Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France
- INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France
- AP-HP, Hôpital Saint-Antoine, Bactériologie-Hygiène, Paris, France
| | - Anthony Mézière
- Assistance Publique-Hôpitaux de Paris (AP-HP), GHU Pitié Salpêtrière-Charles Foix, site Charles Foix, Service de Soins de Suite et Réadaptation orthogériatrique et polyvalent, Fondation d’Heur et Chemin Delatour, Ivry s/Seine, Paris, France
| |
Collapse
|
11
|
|
12
|
Rana M, Sturdevant M, Patel G, Huprikar S. Klebsiellanecrotizing soft tissue infections in liver transplant recipients: a case series. Transpl Infect Dis 2013; 15:E157-63. [DOI: 10.1111/tid.12103] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 02/28/2013] [Accepted: 04/02/2013] [Indexed: 11/27/2022]
Affiliation(s)
- M.M. Rana
- Department of Medicine; Mount Sinai School of Medicine; New York; New York; USA
| | - M. Sturdevant
- Department of Surgery; University of Pittsburgh Medical Center; Pittsburgh; Pennsylvania; USA
| | - G. Patel
- Department of Medicine; Mount Sinai School of Medicine; New York; New York; USA
| | - S. Huprikar
- Department of Medicine; Mount Sinai School of Medicine; New York; New York; USA
| |
Collapse
|
13
|
Klebsiella pneumoniae cervical necrotizing fasciitis originating as an abscess. Am J Otolaryngol 2012; 33:764-6. [PMID: 22809880 DOI: 10.1016/j.amjoto.2012.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 05/20/2012] [Accepted: 05/26/2012] [Indexed: 11/22/2022]
Abstract
Cervical necrotizing fasciitis is a rapidly progressive and devastating infection that is usually caused by a polymicrobial infection including group A Streptococcus and anaerobes. We present a case of a newly diagnosed diabetic man who underwent transoral drainage of a Klebsiella pneumoniae paraglottic abscess, which, despite culture-directed antibiotics, progressed to cervical necrotizing fasciitis with descending mediastinitis. The patient required 12 surgical debridements and sternotomy, but survived and was discharged on hospital day 40. To our knowledge, this is the first case of cervical necrotizing fasciitis caused by a K pneumoniae infection in the United States. The significance of this unusual presentation is discussed.
Collapse
|
14
|
Persichino J, Tran R, Sutjita M, Kim D. Klebsiella pneumoniae necrotizing fasciitis in a Latin American male. J Med Microbiol 2012; 61:1614-1616. [DOI: 10.1099/jmm.0.043638-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jon Persichino
- Department of Internal Medicine, Riverside County Regional Medical Center, Moreno Valley, California, USA
| | - Richard Tran
- Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Made Sutjita
- Infectious Disease Section, Riverside County Regional Medical Center, Moreno Valley, California, USA
| | - Daniel Kim
- Department of Internal Medicine, Riverside County Regional Medical Center, Moreno Valley, California, USA
| |
Collapse
|
15
|
Cheng NC, Yu YC, Tai HC, Hsueh PR, Chang SC, Lai SY, Yi WC, Fang CT. Recent trend of necrotizing fasciitis in Taiwan: focus on monomicrobial Klebsiella pneumoniae necrotizing fasciitis. Clin Infect Dis 2012; 55:930-9. [PMID: 22715175 DOI: 10.1093/cid/cis565] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft-tissue infection that is traditionally caused by group A Streptococcus (GAS) or mixed aerobic/anaerobic bacteria. Monomicrobial Klebsiella pneumoniae NF (KP-NF) has been reported since 1996 but has not yet been systematically studied. METHODS We retrospectively studied consecutive NF cases treated at a university hospital in Taiwan during 1997-2010 and investigated the clinical characteristics and outcomes associated with monomicrobial KP-NF, using monomicrobial GAS-NF as a reference. We also analyzed the virulence gene profiles of the isolated K. pneumoniae strains. RESULTS Of 134 NF cases, 88 were monomicrobial, of which the most common pathogens were GAS (n = 16) and K. pneumoniae (n = 15). Monomicrobial KP-NF entailed a moderate risk of limb loss (20% vs 25%; P = 1.000) and high mortality (47% vs 19%; P = .135), and it was more likely to involve bacteremia (80% vs 31%; P = .011), concomitant distant abscesses (27% vs 0%; P = .043), and underlying immunocompromising conditions (100% vs 63%; P = .018), compared with GAS-NF. The isolated K. pneumoniae strains (n = 10) were of capsular polysaccharides genotype K1 (n = 4), K54/K20/K5 (n = 4), K2 (n = 1), and K16 (n = 1). All strains carried rmpA, iucABCDiutA, and iroA. Genotype K1 strains had a significantly higher risk of concomitant distant abscesses, compared with non-K1 strains (75% vs 0%; P = .033). CONCLUSIONS K. pneumoniae has become a common pathogen of monomicrobial NF in Taiwan. Physicians treating patients with monomicrobial KP-NF should be aware of the risk of concomitant distant abscesses, particularly in cases caused by genotype K1.
Collapse
Affiliation(s)
- Nai-Chen Cheng
- Department of Surgery, National Taiwan University Hospital, Taipei
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Lee SSJ. Editorial commentary: Klebsiella pneumoniae is an emerging major pathogen in necrotizing fasciitis. Clin Infect Dis 2012; 55:940-2. [PMID: 22715174 DOI: 10.1093/cid/cis571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
17
|
Cervical necrotizing fasciitis of odontogenic origin involving the temporal region – A case report. J Craniomaxillofac Surg 2011; 39:570-3. [DOI: 10.1016/j.jcms.2010.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 03/29/2010] [Accepted: 05/11/2010] [Indexed: 11/22/2022] Open
|
18
|
Abstract
With four types of necrotizing fasciitis (NF) now recognized, the diagnosis and management of NF becomes more challenging as physicians face more unusual pathogenic and atypical presentations. With few published guidelines and little evidence base to justify therapies, much of the literature is pragmatic or provides limited evidence with small underpowered studies and disparate case reports.
Collapse
Affiliation(s)
- Marina S Morgan
- Royal Devon & Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK,
| |
Collapse
|
19
|
Mita N, Narahara H, Okawa M, Hinohara H, Kunimoto F, Haque A, Saito S, Oshima K. Necrotizing fasciitis following psoas muscle abscess caused by hypermucoviscous Klebsiella pneumoniae. J Infect Chemother 2011; 18:565-8. [PMID: 22065090 DOI: 10.1007/s10156-011-0338-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 10/20/2011] [Indexed: 11/27/2022]
Abstract
A 59-year-old Japanese diabetic woman was admitted to a small private hospital with general malaise, fever, and a 1-month history of low back pain. A computed tomography scan of the abdomen revealed left abdominal necrotizing fasciitis with suspected left psoas muscle abscess. She was transferred to Gunma University Hospital, received antibiotic therapy, and underwent debridement of the infected subcutaneous tissue, fascia, and necrotic left psoas muscle. She was transferred to the intensive care unit to receive mechanical ventilation and inotropic support. Blood culture showed growth of Klebsiella pneumoniae, from which hypermucoviscosity was detected by the string test. She was extubated on day 5 of hospitalization and transferred to a general ward on day 14. Free skin grafting was performed on day 76, and she was discharged on day 134 without any complications.
Collapse
Affiliation(s)
- Norikatsu Mita
- Department of Anesthesiology, Saitama Cardiovascular and Respiratory Disease Center, 1696 Itai, Kumagaya, Saitama, 360-0105, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Clinical and microbiological spectrum of necrotizing fasciitis in surgical patients at a Philippine university medical centre. Asian J Surg 2010; 33:51-8. [PMID: 20497883 DOI: 10.1016/s1015-9584(10)60009-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The study describes the clinical characteristics, bacteriology and risk factors for mortality of patients with necrotizing fasciitis (NF), seen in a university medical centre. METHODS The medical charts of NF patients admitted to the institution from January 2004 to July 2007 were retrieved and reviewed retrospectively. RESULTS The majority of the 67 patients included in the study presented with localized nonspecific inflammatory manifestations: tenderness (94%), warmth (86%), oedema (76%), skin necrosis (75%), and ulceration (68%). Diabetes mellitus (22%) was the most common predisposing medical condition. The most frequent isolates were Escherichia coli (44%), Acinetobacter baumannii (19%), Staphylococcus aureus (15%) and Enterococcus faecium (15%). Overall mortality rate was 36%. Risk factors significantly associated with mortality were truncal involvement (p = 0.034), leukocytosis (p = 0.038), acidosis (p = 0.001), hypoalbuminaemia (p = 0.004), hypocalcaemia (p = 0.000) and hyponatraemia (p = 0.023). Logistic regression analysis revealed acidosis [p < 0.05, odds ratio (OR) = 9] and hypoalbuminaemia (p < 0.05, OR = 14) as significant independent risk factors for mortality. CONCLUSION The identified risk factors can inform clinicians of increased mortality risks for certain patients with NF. They should serve as a trigger for more aggressive surgical and critical care, and antimicrobial therapy for these patients.
Collapse
|
21
|
Morgan M. Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect 2010; 75:249-57. [DOI: 10.1016/j.jhin.2010.01.028] [Citation(s) in RCA: 173] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 01/13/2010] [Indexed: 01/22/2023]
|
22
|
Postirradiation Klebsiella pneumoniae-associated necrotizing fasciitis in the western hemisphere: a rare but life-threatening clinical entity. Am J Med Sci 2009; 338:217-24. [PMID: 19581796 DOI: 10.1097/maj.0b013e3181a393a4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Necrotizing fasciitis (NF) caused by Klebsiella spp. is a unique entity, particularly, in Asia, where virulent strains of Klebsiella predominate. It is now clear that Klebsiella spp. are capable of causing NF either isolated or in the context of disseminated disease. We present a unique case of NF caused by Klebsiella pneumoniae in the Western hemisphere after radiotherapy in a hospitalized patient with significant comorbidities. Physicians should be aware of nosocomially acquired K. pneumoniae fasciitis after radiotherapy in the setting of chronic comorbidities, such as diabetes and malignancy. Early diagnosis, surgical intervention, and appropriate empirical antibiotics are essential for a favorable outcome in such rare but life-threatening cases of NF.
Collapse
|
23
|
Gunnarsson GL, Brandt PB, Gad D, Struve C, Justesen US. Monomicrobial necrotizing fasciitis in a white male caused by hypermucoviscous Klebsiella pneumoniae. J Med Microbiol 2009; 58:1519-1521. [PMID: 19661201 DOI: 10.1099/jmm.0.011064-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report a case of monomicrobial necrotizing fasciitis caused by hypermucoviscous Klebsiella pneumoniae in an immunocompromised white male after travel to China. The K. pneumoniae isolate belonged to the K2 serotype, and carried the virulence factors RmpA and aerobactin. To the best of our knowledge this is the first report of necrotizing fasciitis caused by hypermucoviscous K. pneumoniae resembling the highly virulent K. pneumoniae isolates associated with liver abscess syndrome in Asia.
Collapse
Affiliation(s)
| | - Pernille B Brandt
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Dorte Gad
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Carsten Struve
- Department of Bacteriology, Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark
| | - Ulrik S Justesen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
24
|
Virulent clones of Klebsiella pneumoniae: identification and evolutionary scenario based on genomic and phenotypic characterization. PLoS One 2009; 4:e4982. [PMID: 19319196 PMCID: PMC2656620 DOI: 10.1371/journal.pone.0004982] [Citation(s) in RCA: 326] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Accepted: 01/31/2009] [Indexed: 11/25/2022] Open
Abstract
Klebsiella pneumoniae is found in the environment and as a harmless commensal, but is also a frequent nosocomial pathogen (causing urinary, respiratory and blood infections) and the agent of specific human infections including Friedländer's pneumonia, rhinoscleroma and the emerging disease pyogenic liver abscess (PLA). The identification and precise definition of virulent clones, i.e. groups of strains with a single ancestor that are associated with particular infections, is critical to understand the evolution of pathogenicity from commensalism and for a better control of infections. We analyzed 235 K. pneumoniae isolates of diverse environmental and clinical origins by multilocus sequence typing, virulence gene content, biochemical and capsular profiling and virulence to mice. Phylogenetic analysis of housekeeping genes clearly defined clones that differ sharply by their clinical source and biological features. First, two clones comprising isolates of capsular type K1, clone CC23K1 and clone CC82K1, were strongly associated with PLA and respiratory infection, respectively. Second, only one of the two major disclosed K2 clones was highly virulent to mice. Third, strains associated with the human infections ozena and rhinoscleroma each corresponded to one monomorphic clone. Therefore, K. pneumoniae subsp. ozaenae and K. pneumoniae subsp. rhinoscleromatis should be regarded as virulent clones derived from K. pneumoniae. The lack of strict association of virulent capsular types with clones was explained by horizontal transfer of the cps operon, responsible for the synthesis of the capsular polysaccharide. Finally, the reduction of metabolic versatility observed in clones Rhinoscleromatis, Ozaenae and CC82K1 indicates an evolutionary process of specialization to a pathogenic lifestyle. In contrast, clone CC23K1 remains metabolically versatile, suggesting recent acquisition of invasive potential. In conclusion, our results reveal the existence of important virulent clones associated with specific infections and provide an evolutionary framework for research into the links between clones, virulence and other genomic features in K. pneumoniae.
Collapse
|
25
|
Klebsiella pneumoniae Necrotizing Fasciitis Associated With Lung Abscess. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2009. [DOI: 10.1097/ipc.0b013e3181730804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
26
|
Greer-Bayramoglu R, Matic DB, Kiaii B, Fortin AJ. Klebsiella oxytoca Necrotizing Fasciitis After Orthotopic Heart Transplant. J Heart Lung Transplant 2008; 27:1265-7. [DOI: 10.1016/j.healun.2008.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Revised: 07/14/2008] [Accepted: 07/29/2008] [Indexed: 10/21/2022] Open
|
27
|
Caputo FJ, Magnotti LJ, Hauser CJ, Livingston DH. Descending necrotizing mediastinitis: unique complication of central venous catheterization. Surg Infect (Larchmt) 2008; 8:611-4. [PMID: 18171121 DOI: 10.1089/sur.2006.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Central venous catheter placement is a common procedure in the intensive care unit. However, these devices are not without complications. We describe the first reported case of descending necrotizing mediastinitis secondary to central venous catheterization without evidence of associated vascular perforation. METHODS Case report and literature review. RESULTS A 24-year-old man developed descending necrotizing mediastinitis after exploratory laparotomy for a gunshot wound. A central venous catheter was presumed to be the source because blood, intraoperative, and catheter tip cultures grew the same Klebsiella organism, and there was no evidence of venous perforation at the initial operation. CONCLUSIONS Prompt recognition, adequate operative drainage, and appropriate antibiotics remain the best treatment for descending necrotizing mediastinitis.
Collapse
Affiliation(s)
- Francis J Caputo
- Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey, USA
| | | | | | | |
Collapse
|
28
|
Capoor MR, Khanna G, Malhotra R, Verma S, Nair D, Deb M, Aggarwal P. Disseminated cryptococcosis with necrotizing fasciitis in an apparently immunocompetent host: a case report. Med Mycol 2008; 46:269-73. [DOI: 10.1080/13693780701675797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
29
|
Kohler JE, Hutchens MP, Sadow PM, Modi BP, Tavakkolizadeh A, Gates JD. Klebsiella pneumoniae necrotizing fasciitis and septic arthritis: an appearance in the Western hemisphere. Surg Infect (Larchmt) 2007; 8:227-32. [PMID: 17437368 DOI: 10.1089/sur.2006.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis caused by Klebsiella pneumoniae is rare, with 11 documented cases in the literature, all occurring in Asia and the Middle East. These reports have become more frequent in recent years in association with the emergence of the highly virulent K1 capsular serotype of Klebsiella. We report a case of Klebsiella necrotizing fasciitis and con-current septic arthritis in the Western hemisphere. METHODS Case report and review of the literature. RESULTS Our patient, a 50-year-old Cambodian man with advanced hepatitis B-associated cirrhosis, who had last visited an endemic area six months prior to presentation, was hospitalized after several days of left knee and thigh pain. He was hypotensive, tachycardic, and bacteremic with K. pneumoniae. A computed tomography scan showed gas in the tissues of the thigh and left knee joint. Despite aggressive surgical debridement and antibiotic therapy, the patient died on day three. Serotyping of blood, wound, and synovial cultures revealed K1-type K. pneumoniae. CONCLUSIONS Although K. pneumoniae is common, monomicrobial necrotizing fasciitis and septic arthritis caused by this pathogen has not been reported previously outside Asia, where it is rare. The appearance of this infection in the Western hemisphere may reflect geographic spread of the aggressive K1 phenotype. Physicians treating patients with symptoms and signs of necrotizing fasciitis or septic arthritis, particularly in the setting of underlying chronic illness or recent travel to Asia, should consider K. pneumoniae as a potential cause and treat accordingly.
Collapse
|
30
|
Abstract
PURPOSE OF REVIEW Acute bacterial skin infections are very common, with various presentations and severity. This review focuses on deep skin infections. We separate acute nonnecrotizing infections of the hypodermis (erysipelas), forms with abscesses or exudates and necrotizing fasciitis. These three types actually differ in risk factors, bacteriology, treatment and prognosis. RECENT FINDINGS Leg erysipelas/cellulitis occurs in more than one person/1000/year. It remains mainly due to streptococci. Foot intertrigo is an important risk factor. Necrotizing fasciitis is much rarer and usually occurs in patients with chronic diseases. Staphylococci, especially community-acquired methicillin-resistant strains in some areas, play a growing role in the intermediate form of cellulitis with abscesses and exudates. For erysipelas or noncomplicated cellulitis, antibiotic treatment at home, when feasible, is much less expensive and as effective as hospital treatment. Intermediate cases with collections and exudates often require surgical drainage. For necrotizing fasciitis early surgery remains essential in order to decrease the mortality rate. SUMMARY Antibiotic treatment of deep skin infections must be active on streptococci; the choice of a larger spectrum of activity depends on clinical presentation, risk factors and the burden of methicillin-resistant staphylococci in the environment.
Collapse
|
31
|
Hohlweg-Majert B, Weyer N, Metzger MC, Schön R. Cervicofacial necrotizing fasciitis. Diabetes Res Clin Pract 2006; 72:206-8. [PMID: 16446008 DOI: 10.1016/j.diabres.2005.09.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 09/21/2005] [Indexed: 11/29/2022]
Abstract
Cervical necrotizing fasciitis is a fast spreading acute soft tissue inflammation. Death can occur within 12-24 h. Early identification and treatment is needed. We report the case of a 75 year old woman with diabetes and high cholesterol, adipositas who developed cervical necrotizing fasciitis of odotongenic origin with massive subcutaneous air collection and first sign of septicaemia. Surgical treatment with debridement and drainage in combination with intravenous broadbased antibiotics as well as daily irrigation of the wound with iodine solution (Betaisodona) and metronidazol (local antibiotic treatment) was performed. The patient recovered completely. Surgical debridement combined with broad-spectrum of antibiotics showed satisfying result for the management of cervical necrotizing fasciitis of dentogenous origin.
Collapse
Affiliation(s)
- Bettina Hohlweg-Majert
- Department of Oral and Maxillofacial Surgery, University Hospital Freiburg, Hugstetterstrasse 55, D-79106 Freiburg, Germany.
| | | | | | | |
Collapse
|
32
|
Abstract
Skin and soft tissue infections are among the most common reasons for people to seek medical advice. They also represent one of the most common indications for antimicrobial therapy and account for approximately 7-10% of hospitalisations in North America. Although non-limb and non-life threatening infections may be treated on an out-patient basis with oral antibiotics, patients with more serious acute skin and soft tissue infections may require admission to hospital for management; this decision is especially true if the infection is rapidly progressive. We provide a concise overview of the differential diagnosis and approach to management of community-acquired rapidly progressive skin and soft tissue infections.
Collapse
Affiliation(s)
- Donald C Vinh
- Section of Infectious Diseases, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | |
Collapse
|
33
|
Yildirim Y, Inal M, Tinar S. Necrotizing fasciitis after abdominal hysterectomy: a report on five cases. Arch Gynecol Obstet 2005; 273:126-8. [PMID: 15991014 DOI: 10.1007/s00404-005-0033-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Accepted: 05/12/2005] [Indexed: 11/25/2022]
Abstract
Necrotizing fasciitis, a severe soft tissue infection, was first described 80 years ago. It occurs rarely in obstetric and gynecology practice. We reviewed medical records of 2,894 women who had underwent an abdominal hysterectomy at the Social Security Agency Aegean Obstetrics and Gynecology Teaching Hospital between 2001 and 2005, and identified 5 (0.17%) cases of necrotizing fasciitis, which are described.
Collapse
Affiliation(s)
- Yusuf Yildirim
- Department of Obstetrics and Gynecology, SSK (Social Security Agency) Aegean Obstetrics and Gynecology Teaching Hospital, Yenisehir, Izmir, Turkey.
| | | | | |
Collapse
|