Monomicrobial necrotizing fasciitis in a single center: the emergence of Gram-negative bacteria as a common pathogen

Yahav, Dafna; Duskin-Bitan, Hadar; Eliakim‐Raz, Noa; Ben‐Zvi, Haim; Shaked, Hila; Goldberg, Elad; Bishara, Jihad

doi:10.1016/j.ijid.2014.05.024

Cited by 40 publications

(43 citation statements)

References 21 publications

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“…In southwest Taiwan, Gram-negative aerobic bacteria, such as V. vulnificus, A. hydrophila, Klebsiella pneumoniae, and Escherichia coli, were the most frequently isolated microorganisms of NF [6-14, 17-22, 24-26], and they can cause more rapid, fulminant, and deadly NF than gram-positive pathogens [8,12,27]. In grampositive aerobic pathogens of NF, β-hemolytic Streptococcus spp.…”

Section: Introductionmentioning

confidence: 99%

“…and S. aureus were extremely important microorganisms [3, 4, 6-10, 12, 16, 22, 27-29]. In comparing gram-negative with gram-positive aerobic NF, the mortality rates of the former group were generally higher than the latter group (17.1-41.2% vs. 9.1-30.8%) [8,12,27]. V. vulnificus causes the most rapid fatal NSSTIs, with most patients having died within 48 h after admission [11,13,25].…”

Section: Introductionmentioning

confidence: 99%

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Predictors for gram-negative monomicrobial necrotizing fasciitis in southern Taiwan

et al. 2020

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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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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictors for gram-negative monomicrobial necrotizing fasciitis in southern Taiwan

et al. 2020

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“…The majority of cases were of the lower extremity, and most of the cases in this review received fasciotomy as the immediate surgical intervention. Klebsiella pneumoniae was associated with the greatest mortality [3].…”

Section: Discussionmentioning

confidence: 97%

Necrotizing Fasciitis in a Panniculus by Gram Negative Bacteria on Surgical Service

Zil-E-AliAhsan¹,

Nicholas

2016

Surgical Infections Case Reports

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Background: Necrotizing fasciitis (NF) is usually caused by group A streptococcus, staphylococcus aureus, or Clostridium perfringens, although it is rare by gram negative bacteria. The management plan is similar irrespective of the organism causing it and always requires early detection of causative bacterial sensitivity, surgical debridement, and appropriate medication, which can minimize the chances of morbidity and mortality. Methods: A 39-year-old morbidly obese female presented with a necrotic wound in the right side of the panniculus that coursed for 7 mo. Debrided tissue cultures indicated presence of Pseudomonas aeruginosa with maximum number of isolates (n = 54), followed by other gram negative organisms. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score of 11 was recorded. On bacterial sensitivity, imipenem and piperacillin-tazobactam was infused after a massive surgical debridement. Results: Post-operatively, vitals were monitored closely and the wound dressing vacuum-assisted closure (VAC)Ò was routinely changed to assure an aseptic surgical site. A score of 4 was achieved on LRINEC in 27 d. Conclusion: Soft tissue infections and necrotizing fasciitis are not the main features of Pseudomonas aeruginosa and other isolates from the specimen. It was a perculiar presentation of the bacteria.

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“…In contrast, there were 12% type I NF (infection by polymicrobial bacteria) and 52% type II (infection by a monomicrobial pathogen, usually Gram-positive bacteria) in El-Khani et al [2]. The different bacteria isolated might be attributable to the different geographical regions and epidemiology of the cases reported [7–9]. Marine bacteria (e.g., Vibrio spp.…”

Section: Discussionmentioning

confidence: 99%

Synchronous multifocal necrotizing fasciitis prognostic factors: a retrospective case series study in a single center

Lee

Huang

et al. 2016

Infection

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PurposeNo reports have been published on synchronous multifocal necrotizing fasciitis (SMNF), a multifocal presence of necrotizing fasciitis in different extremities. We evaluated the clinical characteristics and outcomes of SMNF.MethodsEighteen patients (14 men, 4 women; mean age: 59 years) diagnosed with SMNF of the extremities between January 2004 to December 2012 were enrolled and evaluated.Results Vibrio species were the most commonly (78%; n = 14) isolated; others were two cases (11%) of Aeromonas spp., one case (6%) of group A β-hemolytic streptococcus, and one case of coagulase-negative staphylococcus. SMNF was in the bilateral lower limbs (72%; n = 13), bilateral upper limbs (17%; n = 3), and one patient with one upper and one lower limb (11%). Non-surviving patients had more bilateral lower limb involvement and thrombocytopenia.ConclusionsMost patients with SMNF were male and had bilateral lower limb and marine Gram-negative bacteria involvement. The mortality of SMNF remained extremely high in patients with involvement of bilateral lower limb and initial thrombocytopenia.

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Monomicrobial necrotizing fasciitis in a single center: the emergence of Gram-negative bacteria as a common pathogen

Cited by 40 publications

References 21 publications

Predictors for gram-negative monomicrobial necrotizing fasciitis in southern Taiwan

Predictors for gram-negative monomicrobial necrotizing fasciitis in southern Taiwan

Necrotizing Fasciitis in a Panniculus by Gram Negative Bacteria on Surgical Service

Synchronous multifocal necrotizing fasciitis prognostic factors: a retrospective case series study in a single center

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