Asian Journal of Surgery
Volume 33, Issue 1 , Pages 51-58, January 2010

Clinical and Microbiological Spectrum of Necrotizing Fasciitis in Surgical Patients at a Philippine University Medical Centre

Division of Surgical Critical Care, Department of Surgery, University of the Philippines-Philippine General Hospital, Manila, Philippines

Accepted 24 November 2009.

Article Outline

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.

Key Words:  antimicrobial susceptability , bacteriology , complicated soft tissue infection , Fournier's gangrene , microbiologic spectrum , necrotizing fasciitis , Philippines , surgical patient

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Stamenkovic I , Lew PD . Early recognition of potentially fatal NF: the use of frozen-section biopsy . N Engl J Med . 1984;310:1689–1693
  2. Koehn GG . Necrotizing fasciitis . Arch Dermatol . 1978;114:581–583
  3. Janevicius RV , Hann S , Batt MD . Necrotizing fasciitis . Surg Gynecol Obstet . 1982;154:97–102
  4. Sutherland ME , Meyer AA . Necrotizing soft-tissue infections . Surg Clin North Am . 1994;74:591–607
  5. Sudarsky LA , Laschinger JC , Coppa GF , et al.   Improved results from a standardized approach in treating patients with necrotizing fasciitis . Ann Surg . 1987;206:661–665
  6. Kaul R , McGeer A , Low DE , et al.   Population-based surveillance for group A streptococcal necrotizing fasciitis: clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases . Am J Med . 1997;103:18–24
  7. Wong C , Wang Y . The diagnosis of necrotizing fasciitis . Curr Opin Infect Dis . 2005;18:101–106
  8. Hasham S , Matteucci P , Stanley P , et al.   Necrotizing fasciitis . BMJ . 2005;330:830–833
  9. Hassell M , Fagan P , Carson P , et al.   Streptococcal necrotizing fasciitis from diverse strains of Streptococcus pyogenes in tropical northern Australia: case series and comparison with the literature . BMC Infect Dis . 2004;4:60; [Published Online]
  10. Rouse TM , Malangoni MA , Schulte WJ . Necrotizing fasciitis: a preventable disaster . Surgery . 1982;92:765–770
  11. Yu-Tsung L , Jung-Chung L , Ning-Chi W , et al.   Necrotizing fasciitis in a medical center in northern Taiwan: emergence of methicillin-resistant Staphylococcus aureus in the community . J Microbiol Immunol Infect . 2007;40:335–341
  12. Taviloglu K , Cabioglu N , Cagatay A , et al.   Idiopathic necrotizing fasciitis: risk factors and strategies for management . Am Surg . 2005;71:315–320
  13. Freeman HP , Oluwole SF , Ganepola GAP , et al.   Necrotizing fasciitis . Am J Surg . 1981;142:377–383
  14. Brook I , Frazier E . Clinical and microbiological features of necrotizing fasciitis . J. Clin Microbiol . 1995;33:2382–2387
  15. Majeski JA , Alexander JW . Early diagnosis, nutritional support, and immediate extensive debridement improve survival in necrotizing fasciitis . Am J Surg . 1983;145:784–787
  16. Boyle-Vavra S , Daum R . Community-acquired methicillin-resistant Staphylococcus aureus: the role of Panton-Valentine leukocidin . Lab Invest . 2007;87:3–9
  17. Yen-Yi C , Te-Yu L , Jung-Chung L , et al.   Vancomycin-resistant enterococcal bacteremia: comparison of clinical features and outcome between Enterococcus faecium and Enterococcus faecalis . J Microbiol Immunol Infect . 2008;41:124–129
  18. Treitman A , Yarnold P , Warren J , et al.   Emerging incidence of Enterococcus faecium among hospital isolates (1993 to 2002) . J Clin Microbiol . 2005;43:462–463
  19. Wong CH , Kurup Y , Wang K , et al.   Four cases of NF caused by Klebsiella species . Eur J Clin Microbiol Infect Dis . 2004;23:403–407
  20. McHenry CR , Azar T , Ramahi AJ , et al.   Monomicrobial necrotizing fasciitis complicating pregnancy and puerperium . Obstet Gynecol . 1996;87:823–826
  21. Riseman JA , Zamboni WA , Curtis A , et al.   Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements . Surgery . 1990;5:847–850
  22. Ward RG , Walsh MS . Necrotizing fasciitis: 10 years' experience in a district hospital . Br J Surg . 1991;78:488–489
  23. Giuliano A , Lewis F , Hadley K , et al.   Bacteriology of necrotizing fasciitis . Am J Surg . 1977;134:52–57
  24. Saini S , Gupta N , Lokveer A , et al.   Surgical infections: a microbiological study . Brazilian J Infect Dis . 2004;8:118–125
  25. Wong CH , Chang HC , Pasupathy S , et al.   Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality . J Bone Joint Surg Am . 2003;85:1454–1460
  26. Nguyen HB , Rivers EP , Abrahamian FM , et al.   Severe sepsis and septic shock: review of the literature and emergency department guidelines . Ann Emerg Med . 2006;48:28–54

PII: S1015-9584(10)60009-7

doi:10.1016/S1015-9584(10)60009-7

Asian Journal of Surgery
Volume 33, Issue 1 , Pages 51-58, January 2010

Article Tools