Etiology, characteristics, and outcomes of community-onset necrotizing fasciitis in Korea: A multicenter study

Abstract

Background Necrotizing fasciitis (NF) is a serious skin and soft tissue infection causing high mortality. Investigating region specific epidemiologic factors associated with NF is important for establishing appropriate treatment strategies. This multicenter study was done to provide an update of the microbial etiology, clinical characteristics, and outcomes of NF in Korea. Materials and methods A retrospective cohort of adult patients with NF was established using patient data from 13 general hospitals between January 2012 and December 2015 in Korea. We evaluated microbial etiology and clinical characteristics to identify risk factors associated with in-hospital mortality; analyses were performed using binary logistic regression models. Results A total of 161 patients with NF were included. The most common underlying disease was diabetes mellitus (66 cases, 41.0%). A total of 148 organisms were isolated from 119 (73.9%) patients. Enteric Gram-negative organisms (36 patients) were the most common pathogen, followed by Staphylococcus aureus (30 patients) and streptococci (28 patients). Methicillin-resistant Staphylococcus aureus (MRSA) was identified in 6.2% (10/161) of patients. Of 37 enteric Gram-negative isolates tested, 26 (70.3%) isolates were susceptible to ceftriaxone. The in-hospital mortality rate was 22.4%. Intensive care unit admission, septic shock, and Gram-negative organism infections were significantly associated with in-hospital mortality, and surgery was not a favorable prognostic factor. Conclusions As initial empirical antibiotics, glycopeptides against MRSA and broad-spectrum antibiotics against third-generation cephalosporin-resistant organisms should be considered for patients with community-onset NF in Korea.

Necrotizing Soft Tissue Infection: A Single-Center Retrospective Study of Treatment and Outcomes

“…Most commonly, it is a polymicrobial infection caused by aerobic and anaerobic bacteria. Kim et al reported that 73.9% had one or more identifiable pathogens [ 23 ]. Bair et al stated that a single pathogen was found as the infectious agent in 60.4% and multiple pathogens in 19.8% in their study [ 24 ].…”

Necrotising fascitis - a life-threatening infection: Case reports and literature review

“…Some literature data reported that the prevalence of NF is about 1-4 cases per 100.000 populations; men are commonly affected, with a male-to-female ratio of 3:1 [1]. However, there are studies showing different results, so, male to female ratio by Eke et al is approximately 10:1 [5], and in the study of Kim et al, men accounted for 67.1% [6].…”

Klebsiella pneumoniae necrotizing fasciitis on the upper lip in a patient with uncontrolled diabetes

“…Similar results were reported by multicenter studies in South Korea, with approximately 20% mortality in GAS-NF cases compared to 58% of mortality in K. pneumoniae NF. Moreover, patients with Gram-negative infections were more likely to have chronic alcoholism, intensive care admission, and septic shock [16]. Furthermore, another study reported that NF patients with DM had more than a seven-fold increase in mortality if K. pneumoniae was present in blood cultures and wounds [8,16].…”

“…Moreover, patients with Gram-negative infections were more likely to have chronic alcoholism, intensive care admission, and septic shock [16]. Furthermore, another study reported that NF patients with DM had more than a seven-fold increase in mortality if K. pneumoniae was present in blood cultures and wounds [8,16]. Many cases of K. pneumoniae infection have mixed pathogens, which are more likely to develop bacteremia and distant abscesses.…”