Rational Use of Antibiotics and Education Improved Aeromonas Necrotizing Fasciitis Outcomes in Taiwan: A 19-Year Experience

Abstract

Background. Aeromonas necrotizing fasciitis (NF) causes high rates of amputation and mortality, even after aggressive surgical debridement and antibacterial therapy. This study investigated the effects of rational use of antibiotics and education by infectious disease (ID) physicians on Aeromonas NF treatment outcomes. Methods. Retrospective review for conducted for four years (period I, without an ID physician, December 2001 to December 2005) and 15 years (period II, with an ID physician, January 2006 to March 2021). In period II, the hospital-wide computerized antimicrobial approval system (HCAAS) was also implemented. A pretest-posttest time series analysis compared the two periods. Differences in clinical outcomes, demographics, comorbidities, signs and symptoms, laboratory findings, Aeromonas antibiotic susceptibility, and antibiotic regimens were compared between the two periods. Results. There were 19 patients in period I and 53 patients in period II. Patients had a lower rate of amputation or mortality in period II (35.8%) compared with period I (63.2%). Forty-four patients (61.1%) had polymicrobial infections. In the emergency room, the rate of misdiagnosis decreased from 47.4% in period I to 28.3% in period II, while effective empiric antibiotic usage increased from 21.1% in period I to 66.0% in period II. After the ID physician’s adjustment, 69.4% received monotherapy in period II compared to 33.3% in period I. Conclusions. Because Aeromonas NF had a high mortality rate and was often polymicrobial, choosing an antibiotic regimen was difficult. Using the HCAAS by an experienced ID physician can improve rational antibiotic usage and clinical outcomes in Aeromonas NF.

Chronic Diarrhea Due to Aeromonas hydrophila in an Immunosuppressed Patient with a Pancreas–Kidney Transplant

“…is usually uniformly resistant to penicillin due to inducible chromosomal β-lactamases. However, they are susceptible to aminoglycosides, sulfa drugs, second–fourth generation cephalosporins, carbapenems, fluoroquinolones, and tetracyclines [ 52 , 53 ]. Three major classes of β-lactamases are present in Aeromonas spp.…”

The Impact of Cefuroxime Susceptibility on Aeromonas Necrotizing Fasciitis Outcomes

“…MALDI-TOF MS was used for further verification, and all isolates were successfully identified. In healthy participants, these bacteria can cause diarrhea, biliary tract infections, bloodstream infections, and skin and soft-tissue infections [5,6,[17][18][19][20][21][22]. Immunocompromised patients, such as those with chronic liver disease, chronic kidney disease, diabetes mellitus, or malignant disease, are more susceptible to NF [4,5,13,22].…”

“…Necrotizing fasciitis (NF) caused by Aeromonas species is a rare but potentially life-threatening necrotizing skin and softtissue infection (NSSTI) characterized by rapidly spreading necrosis, particularly in the fascia [3][4][5]. Aeromonas NF has a high mortality (26.4-100%) [3][4][5][6][7] and amputation rate (26.4-50%) despite aggressive surgical and antibiotic treatment [3][4][5][6].…”

“…Often, residents of this region encounter raw seafood, seawater, brackish water, and soil. Thus, Aeromonas species and Vibrio species infections are relatively common [3][4][5][6][7][8][9][10]. Therefore, we set up the Vibrio NSSTI Treatment and Research (VTR) Group with professional staff from specialties such as emergency medicine, intensive care unit (ICU), orthopedic surgery, infectious diseases (ID), and plastic surgery, with a hyperbaric oxygen treatment center [5,6,11,12].…”

“…Thus, Aeromonas species and Vibrio species infections are relatively common [3][4][5][6][7][8][9][10]. Therefore, we set up the Vibrio NSSTI Treatment and Research (VTR) Group with professional staff from specialties such as emergency medicine, intensive care unit (ICU), orthopedic surgery, infectious diseases (ID), and plastic surgery, with a hyperbaric oxygen treatment center [5,6,11,12]. A protocol was developed to diagnose and treat NF with broad-spectrum antibiotics with a third-generation cephalosporin plus glycopeptide, and a hospital-wide computerized antimicrobial approval system (HCAAS) was implemented to ascertain appropriate antibiotic use [6].…”