Necrotizing fasciitis, causative agents and management: a five-year retrospective study in two tertiary care hospitals in Central Malaysia

Abstract

Purpose Necrotizing fasciitis (NF) is a rapidly progressive inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues. The severity of the disease depends on the virulence of the organism and host immunity. There is a paucity of reports on the prevalence of NF causing pathogens and management. Methods Retrospective data of patients treated for NF were collected from two tertiary care hospitals in Central Malaysia between January 2014 and December 2018. Results A total of 469 NF patients were identified. More than half of the NF patients were males (n = 278; 59.28%). The highest number of cases was found among age groups between 30 and 79, with mean age of 56.17. The majority of the NF cases (n = 402; 85.72%) were monomicrobial. Streptococcus spp. (n = 89; 18.98%), Pseudomonas aeruginosa (n = 63; 13.44%) and Staphylococcus spp. (n = 61; 13.01%) were identified as the top three microorganisms isolated. Among the 469 NF cases, 173 (36.8%) were amputated or dead while 296 (63.1%) recovered. Proteus spp. (n = 19; 12.93%), Klebsiella pneumoniae (n = 18; 12.24%) and Escherichia coli (n = 14; 9.52%) were associated with all types of amputations. The most common antibiotic prescribed was unasyn (n = 284; 60.56%), followed by clindamycin (n = 56; 11.94%) and ceftazidime (n = 41; 8.74%). A total of 239 (61.8%) recovered while 148 (38.2%) were either amputated or dead when managed with the unasyn, clindamycin or ceftazidime. Conclusion This study represents the largest NF cases series in Malaysia highlighting the causative agents and management.

The microbiological profile of necrotising fasciitis at a secondary level hospital in Gauteng

“…Group A Streptococcus is a virulent microorganism and was associated with septic shock and kidney failure; however, it was not associated with higher mortality. 17,22 There were only two cases of Group A Streptococcus in our study which were 100% sensitive to penicillin and clindamycin. The choice of antimicrobial therapy in the Scandinavian and Malaysian studies were penicillin (Ampicillin and/or sulbactam in Malaysia) and clindamycin.…”

“…1 The demographics of the patients in our study were similar to the global trend previously reported in the literature with mostly male patients, except that our patients were slightly younger than in previous studies, which reported an average age of more than 50 years. 15,16,17 South Africa is known to suffer from the infamous 'Quadruple burden of disease', which includes trauma of which majority of trauma victims are young patients. 18 Less than 50% of the study population had no comorbidities and only human immunodeficiency virus (HIV) and diabetes mellitus were reported.…”

Laboratory risk indicator for necrotising fasciitis [LRINEC] score as a tool for differentiating necrotising fasciitis from other soft tissue infections

“…In a recent retrospective study by Rampal et al, 60% of patients were male (15). Many reported studies showed the male predominance with highest number of cases among age groups between 50 and 60 years (5,12,(15)(16)(17).…”