Causative Micro-Organisms in Necrotizing Fasciitis and their Influence on Inflammatory Parameters and Clinical Outcome

Breidung, David; Malsagova, Asja T.; Loukas, Alexios; Billner, Moritz; Aurnhammer, F.; Reichert, Bert; Megas, Ioannis-Fivos

doi:10.1089/sur.2022.317

Cited by 4 publications

(5 citation statements)

References 31 publications

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“…Only the further subdivision into Gram-positive and Gram-negative bacteria revealed statistically significant values among survivors within the Gram-positive group (p = 0.04). This is in line with the previous results of our research group, which identified Gram-negative infections as more dangerous, Gram-positive infections as more frequent, but also not statistically significant [3].…”

Section: Discussionsupporting

confidence: 93%

“…Type 1 comprises mainly polymicrobial infections, which account for the majority of cases. Type 2 denotes monomicrobial infections caused by Gram-positive pathogens, whereas Type 3 involves Gram-negative pathogens, and Type 4 encompasses fungal infections [ 2 , 3 ]. Despite its rarity, necrotizing fasciitis should be considered as a possible diagnosis in various scenarios of soft tissue infections, as it progresses rapidly [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Factors in Necrotizing Fasciitis: Insights from a Two-Decade, Two-Center Study Involving 209 Cases

Megas,

Delavari,

Marti Edo

et al. 2024

Infectious Disease Reports

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Introduction: Necrotizing fasciitis (NF) is a critical disease with high morbidity and mortality rates that poses significant challenges in diagnosis and treatment. Prognostic factors for the clinical course of NF remain unclear and are currently under research. This study aims to identify such factors in a large cohort of patients which represents a major comprehensive investigation of prognostic factors for NF. Methods: Retrospective analysis was conducted on necrotizing fasciitis cases from 2003 to 2023 at two German hospitals. Data included demographics, comorbidities, laboratory findings, infection site, causative microorganisms and outcomes. Statistical analysis involved t-tests, chi-square tests, and ROC analysis. Results: A total of 209 patients were included, with a mortality rate of 18%. Patients were categorized into survivors (n = 171) and non-survivors (n = 38). Non-survivors were significantly older (68.9 ± 13.9 years vs. 55.9 ± 14.3 years; p < 0.01) and exhibited a higher prevalence of peripheral vascular diseases, cancer, and heart, liver, or renal insufficiency. Laboratory findings and scoring results also varied significantly between the two groups. The ROC curve analysis identified age as a predictor of mortality, with an optimal cut-off value of 68.5 years (sensitivity: 60.5%, specificity: 81.9%). Higher age was associated with increased mortality risk. Conclusions: The patient’s age stands out as the primary predictive element for mortality in necrotizing fasciitis. Additionally, we advocate for employing the Laboratory and Anamnestic Risk Indicator for Necrotizing Fasciitis (LARINF—score), which holds substantial prognostic significance and is straightforward to calculate. Considering our findings, crafting a clinical algorithm or scoring mechanism to forecast mortality in NF would be a promising target for future research.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Prognostic Factors in Necrotizing Fasciitis: Insights from a Two-Decade, Two-Center Study Involving 209 Cases

Megas,

Delavari,

Marti Edo

et al. 2024

Infectious Disease Reports

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“…The Finegoldia magna presented in this case report is a rather rare pathogen in NF. 8 Begaj et al described the first case of NF due to Finegoldia magna on the abdominal wall in their 2020 case report, in which an overhanging panniculus was also reported, although, as opposed to our case, no previous surgical treatment was performed on the patient. 9 Another case of NF of the abdominal wall caused by Finegoldia magna was presented in 2021 by Thomas et al 10 Again, no surgery was reported before the onset of NF in this patient.…”

Section: Discussionmentioning

confidence: 54%

Necrotizing Fasciitis after Panniculectomy Caused by Finegoldia magna

Breidung,

Delavari,

Megas

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Summary: Necrotizing fasciitis is a rare yet severe complication after body contouring surgery. We present a case of a 54-year-old woman with a complex medical history who developed necrotizing fasciitis 9 days after panniculectomy and epigastric hernia repair. Microbiological examination revealed Finegoldia magna as the causative agent, a rare pathogen in necrotizing fasciitis. Patients undergoing body contouring may be at increased risk of developing necrotizing fasciitis; therefore, increased attention should be paid to this differential diagnosis in case of postoperative signs of infection. This case report highlights the pivotal importance of early recognition, prompt surgical intervention, and comprehensive medical treatment to improve patient outcomes in necrotizing fasciitis.

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“…[43][44][45] Laboratory and anamnestic risk indicator for necrotizing fasciitis and site other than the lower limb, immunosuppression, age <60 years, renal impairment, and inflammatory markers (SIARI) scores are newer tools that have been deemed useful. 47 Moreover, SIARI was shown to possess higher diagnostic ability than LRINEC score. 48 However, it is essential to note that emergent debridement must be undertaken regardless of the laboratory index scoring, especially in cases with a high clinical suspicion.…”

Section: Introductionmentioning

confidence: 99%

“…36 The risk of NF can also be obtained using laboratory index measures based on serum parameters, clinical presentation, and associated comorbidities (Table 2). [37][38][39][40][41][42][43][44][45][46][47][48] One such scoring tool is the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), which classifies patients into risk categories with algorithms for diagnostic resources. [38][39][40][41] However, the diagnostic value of LRINEC decreases in patients with multiple comorbidities (due to weakened inflammatory response) and after some hospital interventions, such as blood transfusion.…”

Section: Introductionmentioning

confidence: 99%

Practical Review of Necrotizing Fasciitis: Principles and Evidence-based Management

Guliyeva,

Huayllani,

Sharma

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Summary: Necrotizing fasciitis is a severe, life-threatening soft tissue infection that presents as a surgical emergency. It is characterized by a rapid progression of inflammation leading to extensive tissue necrosis and destruction. Nonetheless, the diagnosis might be missed or delayed due to variable and nonspecific clinical presentation, contributing to high mortality rates. Therefore, early diagnosis and prompt, aggressive medical and surgical treatment are paramount. In this review, we highlight the defining characteristics, pathophysiology, diagnostic modalities, current principles of treatment, and evolving management strategies of necrotizing fasciitis.

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Causative Micro-Organisms in Necrotizing Fasciitis and their Influence on Inflammatory Parameters and Clinical Outcome

Cited by 4 publications

References 31 publications

Prognostic Factors in Necrotizing Fasciitis: Insights from a Two-Decade, Two-Center Study Involving 209 Cases

Prognostic Factors in Necrotizing Fasciitis: Insights from a Two-Decade, Two-Center Study Involving 209 Cases

Necrotizing Fasciitis after Panniculectomy Caused by Finegoldia magna

Practical Review of Necrotizing Fasciitis: Principles and Evidence-based Management

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