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Open Access Highly Accessed Research article

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

Ching-Yu Lee1, Liang-Tseng Kuo1, Kuo-Ti Peng12, Wei-Hsiu Hsu123*, Tsan-Wen Huang1 and Ying-Chao Chou4

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

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

Published: 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.