Infect Chemother.  2012 Jun;44(3):180-184. 10.3947/ic.2012.44.3.180.

Clinical Characteristics and Causative Organisms of Community-acquired Necrotizing Fasciitis

• Choi SH
• Choi SH
• Kwak YG
• Chung JW
• Choo EJ
• Kim KH
• Yun NR
• Lee S
• Kwon KT
• Cho JH
• Kim NJ

• KMID: 2170368
• DOI: http://doi.org/10.3947/ic.2012.44.3.180

Abstract

BACKGROUND
Necrotizing fasciitis (NF) is an infrequent but potentially lethal infection characterized by rapid progressive destruction of fascia and fat, concomitant systemic toxicity, and high fatality. In spite of the clinical significance of NF, only limited data is available regarding the clinical characteristics of patients with NF in Korea.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of patients who had been diagnosed as community-acquired NF in 9 centers of the Republic of Korea between January 2000 and November 2010.
RESULTS
During the study period, a total of 103 patients had a community-acquired NF. Of sixty six cases with causative microorganisms identified, the majority (55, 83.3%) had monomicrobial infections. Whereas streptococci were the most common cause of NF in patients without underlying diseases (16/24, 66.7%), variable organisms, such as staphylococci, streptococci, Enterobacteriaceae, and non-fermentative Gram-negative bacilli were causative organisms of NF in patients with underlying diseases. The majority of patients with NF caused by Vibrio vulnificus or Aeromonas hydrophila (7/9, 77.8%) had liver cirrhosis or alcoholism. Surgery to counteract NF was performed in 60.2% of patients with NF (62/102), and mean time to surgery was 3 days. In-hospital mortality was observed in 21 of 99 patients with available data (21.2%). In multivariate analysis, the presence of solid tumors (adjusted OR [aOR]=63.88, 95% CI=2.58-1580.61, P=0.011), shock (aOR= 24.19, 95% CI=2.00-292.19, P=0.012), bacteremia (aOR=87.53, 95% CI=3.99-1921.46, P=0.005), and Gram-negative bacilli infections (aOR=437.11, 95% CI=4.67-40956.82, P=0.009) were associated with in-hospital mortality.
CONCLUSIONS
Streptococci were predominant causative organisms of community-acquired NF in patients without underlying diseases. However, in patients with underlying diseases, variable organisms such as staphylococci, streptococci, Enterobacteriaceae, or non-fermentative Gram-negative bacilli were isolated. NF caused by V. vulnificus or A. hydrophila occurred frequently in patients with liver cirrhosis or alcoholism.

Keyword

Necrotizing fasciitis

MeSH Terms

Aeromonas hydrophila
Alcoholism
Bacteremia
Enterobacteriaceae
Fascia
Fasciitis, Necrotizing
Hospital Mortality
Humans
Liver Cirrhosis
Medical Records
Multivariate Analysis
Republic of Korea
Retrospective Studies
Shock
Vibrio vulnificus

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