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Monomicrobial necrotizing fasciitis is rapidly progressive and life-threatening. Ching-Yu Lee, of the Department of Orthopedic Surgery at Chang Gung Memorial Hospital in Taiwan, and colleagues, sought to ascertain whether the clinical presentation and outcome for patients with this disease differ for those infected with a Gram-positive pathogen as compared to a Gram-negative pathogen. Their research was published in BMC Infectious Diseases.
Lee, et al. report that 46 patients with monomicrobial necrotizing fasciitis were examined retrospectively from November 2002 to January 2008. All patients received adequate broad-spectrum antibiotic therapy, aggressive resuscitation, prompt radical debridement and adjuvant hyperbaric oxygen therapy. Eleven patients were infected with a Gram-positive pathogen (Group 1) and 35 patients with a Gram-negative pathogen (Group 2).
The researchers report that Group 2 was characterized by a higher incidence of hemorrhagic bullae and septic shock, higher APACHE II scores at 24 h post-admission, a higher rate of thrombocytopenia, and a higher prevalence of chronic liver dysfunction. Gouty arthritis was more prevalent in Group 1. For non-survivors, the incidences of chronic liver dysfunction, chronic renal failure and thrombocytopenia were higher in comparison with those for survivors. Lower level of serum albumin was also demonstrated in the non-survivors as compared to those in survivors.
Lee, et al. write, ""Prognosis for the patient with necrotizing fasciitis is heavily dependent on initiation of appropriate empiric antibiotic treatment. Therefore, approaches that can assist the physician in the rapid identification of the responsible microbial pathogen are needed. It is currently unclear whether the presentation and/or prognosis for patients with monomicrobial necrotizing fasciitis differ as a function of infection with a gram-positive as compared to a gram-negative pathogen. The purposes of this study were to compare the clinical characteristics of patients suffering from these two classes of monomicrobial necrotizing fasciitis and to evaluate the effects of treatments including parenteral antibiotics, debridement and hyperbaric oxygen therapy on these two classes of infection. It was hoped that such information would serve to predict more accurately the outcome for patients with monomicrobial necrotizing fasciitis as well as to provide a guide for better management of this disease."
The researchers conclude that "Pre-existing chronic liver dysfunction, chronic renal failure, thrombocytopenia and hypoalbuminemia, and post-operative dependence on mechanical ventilation represent poor prognostic factors in monomicrobial necrotizing fasciitis. Patients with gram-negative monobacterial necrotizing fasciitis present with more fulminant sepsis. Treatment protocols which include aggressive resuscitation, rapid administration of antibiotics and immediate surgical intervention are recommended for all patients presenting with monomicrobial necrotizing fasciitis."
Reference: Lee CY, Kuo LT, Peng KT, Hsu WH, Huang TW and Chou YC. Prognostic Factors and Monomicrobial Necrotizing Fasciitis: Gram-positive versus Gram-negative Pathogens. BMC Infectious Diseases 2011, 11:5doi:10.1186/1471-2334-11-5.