Prognostic factors and monomicrobial necrotizing fasciitis: gram-positive versus gram-negative pathogens
- Equal contributors
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
BMC Infectious Diseases 2011, 11:5 doi:10.1186/1471-2334-11-5Published: 5 January 2011
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.
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).
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.
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.