Research article

Prognostic factors and monomicrobial necrotizing fasciitis: gram-positive versus gram-negative pathogens

Ching-Yu Lee^1†, Liang-Tseng Kuo^1†, Kuo-Ti Peng^1,2, Wei-Hsiu Hsu^1,2,3*, Tsan-Wen Huang¹ and Ying-Chao Chou⁴

• * Corresponding author: Wei-Hsiu Hsu 7572@cgmh.org.tw

• † Equal contributors

Author Affiliations

¹ Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia Yi, (6 West Section Chia Pu Road), Chia Yi Hsien,(613), Taiwan

² Chang Gung University, (259 Wen-Hwa 1st Road, Kwei-Shan), Tao-Yuan, (333), Taiwan

³ Hyperbaric Oxygen Therapy Center, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia Yi, (6 West Section Chia Pu Road), Chia Yi Hsien,(613), Taiwan

⁴ Department of Orthopedic Surgery, Chang Gung Medical Center,(5, Fu-Hsing St, Kwei-Shan), Tao-Yuan,(333), Taiwan

For all author emails, please log on.

BMC Infectious Diseases 2011, 11:5 doi:10.1186/1471-2334-11-5

Published: 5 January 2011

Abstract

Background

Monomicrobial necrotizing fasciitis is rapidly progressive and life-threatening. This study was undertaken to ascertain whether the clinical presentation and outcome for patients with this disease differ for those infected with a gram-positive as compared to gram-negative pathogen.

Methods

Forty-six 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).

Results

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.

Conclusions

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.