Polymicrobial and monomicrobial necrotizing soft tissue infections: comparison of clinical, laboratory, radiological, and pathological hallmarks and prognosis. A retrospective analysis

Abstract

BackgroundNecrotizing soft tissue infection (NSTI) is a life-threatening infection associated with high morbidity and mortality. Treatment consists of surgery and antibiotics. Many studies have addressed NSTI and its subtypes, but few have reviewed the clinical, radiological, and pathological differences between the polymicrobial and monomicrobial diseases. The objective of our study was to evaluate the clinical, radiological, and pathological features of patients with polymicrobial (NSTI I) and monomicrobial (NSTI II) infections and their association with outcome.MethodsThe cohort consisted of patients hospitalized with NSTI at a tertiary medical center in 2002–2019. The medical charts were reviewed for clinical, radiological, and pathological features. Findings were compared between patients in whom blood/tissue bacterial cultures yielded one or more than one pathological isolate. The primary clinical outcome measure of the study was all-cause mortality at 90 days. Secondary outcomes were duration of hospitalization, intensive care unit (ICU) admission, score on the LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis), and need for vasopressor treatment.ResultsA total of 81 patients met the inclusion criteria: 54 (66.6%) with monomicrobial NSTI and 27 (33.3%) with polymicrobial NSTI. There were no significant between-group differences in in-hospital and 90-day mortality. On multivariate analysis, the monomicrobial disease group had a significantly higher 90-day mortality rate in addition to higher rates of in-hospital mortality, ICU admission, and vasopressor use than the polymicrobial disease group.ConclusionOur study is the first to compare the clinical, radiological, and pathological differences between the two most common types of NSTI. The results demonstrate better prognosis for polymicrobial NSTI, with minimal ICU stay, lower mortality, and lower use of vasopressors.Level of evidencePrognostic and epidemiological, level III.

In-hospital mortality associated with necrotizing soft tissue infection due to Vibrio vulnificus: a matched-pair cohort study

“…Mortality from NSTI caused by gram-negative or monomicrobial pathogen has been reported to be higher than caused by other pathogens. Namany et al [ 16 ] found that monomicrobial disease group had a significantly higher 90-day mortality rate in addition to higher rates of in-hospital mortality, ICU admission, and vasopressor use than the polymicrobial disease group. Huang et al [ 17 ] revealed that NSTI caused by monomicrobial Aeromonas spp.…”

Unreliable diagnostic accuracy of laboratory risk indicator for necrotizing fasciitis (LRINEC) score but good outcome predictor in necrotizing fasciitis due to Vibrio vulnificus: A retrospective and matched-pair study

“…Studies reported that monomicrobial NF had a significantly higher in-hospital mortality, ICU admission, and vasopressor use than the polymicrobials. [24,25] They voiced regarding the escalating risk of singular microbial infection and the presence of gram-negative pathogen. Prior research has evidenced that hyperlactatemia holds a significant correlation with in-hospital mortality in NF patients, even after adjusting for acidosis.…”

Breast rescue after necrotizing fasciitis

“…The monomicrobial type is less common but more dangerous because the causative bacteria is mainly group A beta-hemolytic streptococcus with very rapid necrosis, aggressive infection and multiple-organ failure due to streptococcal toxic shock syndrome [ 5 , 7 ]. On the opposite, polymicrobial type (Type 1) is more frequent and the causative organism are the normal skin commensalism, the gravity of this type is related to the immunosuppression of the host [ 8 ].…”