Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital

Jabbour, Gaby; El‐Menyar, Ayman; Peralta, Rubén; Shaikh, Nissar; Abdelrahman, Husham; Mudali, Insolvisagan Natesa; Ellabib, Mohamed; Al-Thani, Hassan

doi:10.1186/s13017-016-0097-y

Cited by 84 publications

(120 citation statements)

References 44 publications

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“…The demographics of our cohort display the same trends as have been described in other studies (Table ). NSTI patients, both survivors and non‐survivors, were older than abscess patients (p‐value 0.029 and 0.005, respectively).…”

Section: Resultssupporting

confidence: 60%

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Obligate anaerobes are abundant in human necrotizing soft tissue infection samples – a metagenomics analysis

Zhao-Fleming

Wilkinson²,

Larumbe

et al. 2019

APMIS

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Necrotizing soft tissue infections (NSTIs) are associated with high morbidity and mortality and are increasing in incidence. Proper identification of the microbial causes of NSTIs is a crucial step in diagnosis and treatment, but the majority of data collected are culture based, which is biased against fastidious organisms, including obligate anaerobes. The goal of this study was to address this gap in knowledge by characterizing NSTI microbial communities through molecular diagnostics. We performed 16S rRNA sequencing on human NSTI samples and identified five genera most commonly found in NSTIs (Prevotella, Bacteroides, Peptoniphilus, Porphyromonas, and Enterococcus). We found that a >70% contribution of obligate anaerobes to the bacterial population distribution was associated with NSTI mortality, and that NSTI samples, from both survivors and non‐survivors, had an increased relative abundance of gram negative bacteria compared to those of abscess patients. Based on our data, we conclude that obligate anaerobes are abundant in NSTIs and a high relative abundance of anaerobes is associated with a worse outcome. We recommend increasing anaerobe antibiotic coverage during the treatment of NSTIs even when anaerobes are not found by traditional clinical microbiology methods, and especially when there is a clinical suspicion for anaerobe involvement.

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Section: Resultssupporting

confidence: 60%

“…There have been numerous reports on the microbiology of NSTIs , but they have almost always used data obtained by traditional culture methods. Furthermore, many institutions report culture‐negative results in a rapidly progressive wound bed , further illustrating the restraints of culture‐based diagnostics.…”

Section: Discussionmentioning

confidence: 99%

Obligate anaerobes are abundant in human necrotizing soft tissue infection samples – a metagenomics analysis

Zhao-Fleming

Wilkinson²,

Larumbe

et al. 2019

APMIS

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“…Although Vibrio NF has high mortality, our study showed that this had no clinical correlation with mortality in late amputation. Jabbour et al reported that among gram-positive bacteria in NF, Streptococcus and Staphylococcus were the most commonly identified organisms [18]. In our study, V. vulnificus accounted for 34.6%, while Streptococcus species and polymicrobial infection both accounted for 13.2% of cases.…”

Section: Discussionsupporting

confidence: 45%

Risk factors for mortality in the late amputation of necrotizing fasciitis: a retrospective study

et al. 2018

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BackgroundNecrotizing fasciitis (NF) is a rapidly progressive infectious disease that primarily involves the fascia and subcutaneous tissue. If not promptly treated, it can lead to morbidity as well as mortality. It can affect any part of the body, most commonly the extremities. Early and aggressive surgical treatment is the proper way of management. The purpose of this study was to identify the risk factors for mortality in late amputation among NF patients that may be used in routine clinical practice to prevent mortality.MethodsA retrospective cohort study of hospitalized patients with NF was conducted in a tertiary teaching hospital in Taiwan between March 2015 and March 2018. All collected data were statistically analyzed.ResultsA total of 582 patients with NF were included; 35 of them had undergone amputation (7 primary and 28 late amputations), with a 6% amputation rate. Thirteen amputated patients still died eventually (all in the late amputation group). Significant risk factors for mortality identified in the late amputation group included hemorrhagic bullae (p = 0.001, OR 4.7, 95% confidence interval (CI) 2.68–8.69), peripheral vascular disease (p < 0.001, OR 3.2, 95% CI 1.12–10.58), bacteremia (p = 0.021, OR 2.87, 95% CI 2.07–5.96), and Laboratory Risk Indicator of Necrotizing Fasciitis (LRINEC) score > 8 (p < 0.001, OR 1.97, 95% CI 1.28–4.61). Vibrio vulnificus was the main causative organism based on our study, but the microbiology results showed no significant correlation.ConclusionNF patients with hemorrhagic bullae, comorbidity with peripheral vascular disease, presence of bacteremia, or LRINEC score > 8 should receive early and primary amputation in order to prevent mortality.

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“…Polybacterial infections were the most frequent among the other groups (33%). The latter is expected because NF is, by definition, a form of deep tissue infection whereas PG is a reactive, non‐infectious unlike that reported the literature, in our study cohort, we identified Pseudomonas as a predominant gram‐negative microorganism and Enterobacter as a gram‐positive microorganism …”

Section: Discussionmentioning

confidence: 47%

“…First introduced by Wilson in 1952 as a more accurate description, necrotising fasciitis (NF) is an uncommon condition with an incidence rate of 4 to 13/1 000 000 annually . It is mostly a polymicrobial, severe soft tissue infection that progresses rapidly, penetrating through the subcutaneous tissue to the fascial planes and the muscles.…”

Section: Introductionmentioning

confidence: 99%

Necrotising fasciitis or pyoderma gangrenosum: A fatal dilemma

Demirdöver

Geyik

Vayvada

2019

International Wound Journal

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Necrotising fasciitis (NF) is mostly a polymicrobial, severe soft tissue infection that progresses rapidly, penetrating through the subcutaneous tissue to the fascial planes and the muscles. The pyoderma gangrenosum (PG), on the other hand, is a rare, rapidly progressive (except for the post‐surgical PG), autoinflammatory ulcerative skin and soft tissue condition. In this study, we tried to emphasise the importance of diagnosing the NF as well as the PG. Although these two clinical presentations have some standard features, awareness of different symptoms in detail affect the outcome. Any surgical discipline can face NF or PG and, therefore, should be aware of them to decrease the mortality rate. Forty‐five patients with NF and PG who were treated between January 2008 and October 2018 were included in the study and evaluated retrospectively for age, sex, localisation, onset of symptoms and diagnosis, predisposing factors, characteristics of tissue defects, laboratory findings, Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scores, isolated microbiological agents, surgical intervention, and mortality rate. Demographic, laboratory, and clinical data were analysed. Among these 45 patients, 14 patients had PG, and 31 patients had NF. The mean age and SD for the NF and PG groups were 50.80 ± 17.67 and 50.78 ± 12.72, respectively. Five patients had rheumatological disorders; four patients had diabetes mellitus (DM) in the PG group. Males had higher risk than females in NF (odds ratio [OR] = 0.077, 95% confidence interval [CI] 0.017‐0.34), and females had higher risk in PG (relative risk [RR] = 5). We compared the LRINEC score of NF patients with PG patients. The mean value of this score was 4.53 for PG patients, and 6.06 for NF patients. Fifteen patients (33.3%) had a radiological evaluation. MRI, CT, and USI were used as imaging modalities. Necrotising fasciitis and PG are two distinct entities that are in general difficult to distinguish. Therefore, differential diagnosis and rapid treatment are crucial for lowering the mortality rate.

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Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital

Cited by 84 publications

References 44 publications

Obligate anaerobes are abundant in human necrotizing soft tissue infection samples – a metagenomics analysis

Obligate anaerobes are abundant in human necrotizing soft tissue infection samples – a metagenomics analysis

Risk factors for mortality in the late amputation of necrotizing fasciitis: a retrospective study

Necrotising fasciitis or pyoderma gangrenosum: A fatal dilemma

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