Four cases of necrotizing fasciitis caused by Klebsiella species

Abstract

Presented here are four cases of necrotizing fasciitis caused by Klebsiella spp. that were treated at one hospital over a 2-year period. Klebsiella necrotizing fasciitis can occur via direct inoculation, local trauma or, more commonly, hematogenous spread from other septic foci. Early, aggressive, surgical debridement and appropriate antimicrobial treatment are the cornerstones of treatment for this condition. Necrotizing fasciitis due to Klebsiella spp. is unique in that it is commonly associated with multiple septic foci. While liver abscesses and endogenous endophthalmitis are better-known associations of disseminated Klebsiella infection, necrotizing fasciitis is increasingly recognized as one of the manifestations of this syndrome. When treating Klebsiella necrotizing fasciitis, awareness of the potential for multiorgan involvement should prompt a thorough search for associated foci of infection.

Klebsiella pneumoniae necrotizing fasciitis of the leg in an elderly French woman

“…Reasons for an increased susceptibility to K. pneumoniae necrotizing fasciitis in the elderly could include immunosenescence and malnutrition, as well as a large number of age-associated physiological changes 22,23. To the best of our knowledge, K. pneumoniae necrotizing fasciitis has not been reported previously in such an elderly patient 6,9,16,18,20…”

“…K. pneumoniae is an enteric Gram-negative rod mostly implicated in hospital-acquired urinary tract infections, pneumonia, septicemia, and intra-abdominal infections. In Asia, K. pneumoniae necrotizing fasciitis was reported for the first time in 1996 in patients with comorbidities including diabetes mellitus, hepatobiliary disease, malignancy, and acquired immunodeficiency syndrome 6–11…”