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Huang TY, Peng KT, Hsiao CT, Fann WC, Tsai YH, Li YY, Hung CH, Chuang FY, Hsu WH. Predictors for gram-negative monomicrobial necrotizing fasciitis in southern Taiwan. BMC Infect Dis 2020; 20:60. [PMID: 31959118 PMCID: PMC6972015 DOI: 10.1186/s12879-020-4796-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/15/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a rare and life-threatening necrotizing skin and soft-tissue infection. Infectious pathogens of NF must be detected early and treated rapidly to prevent loss of limb or a fatal outcome. This study aimed to detect more reliable predictors between gram-negative and gram-positive monomicrobial NF of limbs. METHODS A total of 100 patients with limb monomicrobial NF were diagnosed prospectively from April 2015 to July 2018. These monomicrobial NF pathogens can be divided into gram-negative and gram-positive groups according to the result of Gram staining and final bacterial reports. Data such as demographics, seawater or seafood contact history, infectious location, comorbidities, presenting signs and symptoms, and laboratory findings were recorded and compared. RESULTS A total of 55 patients were infected with gram-negative organisms and 45 patients with gram-positive organisms. Among the 55 cases of monomicrobial gram-negative NF, 48 (87.3%) were caused mainly by Vibrio spp. (38, 69.1%) and Aeromonas spp. (10, 18.2%). A higher incidence of chronic kidney disease, cerebrovascular accident, tachypnea, and septic shock; a higher rate of band forms of leukocytes of more than 3%, serum lactate of more than 20 mg/dL, and C-reactive protein level of less than 150 mg/dL; prolonged prothrombin time; and a lower fibrinogen level were observed in patients with gram-negative infection. In a multivariate analysis, a higher incidence of seawater or seafood contact history (odds ratio [OR]: 66.301; 95% confidence interval [CI]: 7.467-588.702), a higher rate of hyperlactatemia (OR: 7.904; 95% CI: 1.231-50.744), and a low fibrinogen level (OR: 1.013; 95% CI: 1.004-1.023) indicated gram-negative infection. CONCLUSIONS In southern Taiwan, NF of limbs mainly affected the lower limbs, exhibited monomicrobial infection, and was predominated by gram-negative bacteria. Gram-negative monomicrobial NF of limbs often occurred in individuals with the more seawater or seafood contact history, hyperlactatemia, and low fibrinogen levels.
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Affiliation(s)
- Tsung-Yu Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Ti Peng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West section, Chia-Pu Road, Pu-Zih city, Chiayi, 61363, Taiwan.,Department of Medicine, School of Medicine, Chang Gung University, Tao Yuan, Taiwan
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wen-Chih Fann
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hung Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West section, Chia-Pu Road, Pu-Zih city, Chiayi, 61363, Taiwan
| | - Yen-Yao Li
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West section, Chia-Pu Road, Pu-Zih city, Chiayi, 61363, Taiwan
| | - Chien-Hui Hung
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Fang-Yi Chuang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Hsiu Hsu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West section, Chia-Pu Road, Pu-Zih city, Chiayi, 61363, Taiwan. .,Department of Medicine, School of Medicine, Chang Gung University, Tao Yuan, Taiwan.
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Xu YE, Gounder V. A rare case of multi-focal non-contiguous necrotizing soft tissue infections and literature review. J Surg Case Rep 2019; 2019:rjz338. [PMID: 31768248 PMCID: PMC6865341 DOI: 10.1093/jscr/rjz338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/09/2019] [Accepted: 10/14/2019] [Indexed: 11/22/2022] Open
Abstract
Necrotising soft tissue infection (NSTI) is a rare yet life-threatening surgical emergency, characterized by rapidly spreading infection below the epidermis to the soft tissue layers of the dermis, subcutaneous layers, fascia and sometimes muscle. Multi-focal NSTIs have been rarely described in the literature, with reported cases predominantly involving immunocompromised patients. We report a case of an immunocompromised 70-year-old woman who initially presented with concern of a perforated colonic malignancy requiring exploratory laparotomy and within 24 hours while on inotropes, developed rapidly progressing necrotizing fasciitis (NF) of the left thigh with renal failure secondary to sepsis. Despite aggressive debridement, a progress computed tomography later showed multi-focal non-contiguous necrotising myositis of the whole left lower limb and right gluteal regions. Early diagnosis of multi-focal NF especially in immunocompromised patients, repeat assessment, aggressive surgical debridement and prompt antibiotics usage are the key to treatment.
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Affiliation(s)
- Yaying Eileen Xu
- General Surgical Department, Caboolture Hospital, Brisbane 4510, Australia
| | - Vinay Gounder
- General Surgical Department, Caboolture Hospital, Brisbane 4510, Australia
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