Clinical Characteristics and Causative Organisms of Community-acquired Necrotizing Fasciitis

Seong-Ho Choi; Sang-Ho Choi; Yee Gyung Kwak; Jin-Won Chung; Eun Joo Choo; Kye-Hyung Kim; Na Ra Yun; Shinwon Lee; Ki Tae Kwon; Jae-Hyun Cho; Nam Joong Kim

doi:10.3947/ic.2012.44.3.180

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Choi, Choi, Kwak, Chung, Choo, Kim, Yun, Lee, Kwon, Cho, and Kim: Clinical Characteristics and Causative Organisms of Community-acquired Necrotizing Fasciitis

Original Article

Infection & Chemotherapy

Infection & Chemotherapy 2012; 44(3): 180-184.

Published online: 30 June 2012

DOI: https://doi.org/10.3947/ic.2012.44.3.180

Clinical Characteristics and Causative Organisms of Community-acquired Necrotizing Fasciitis

Seong-Ho Choi¹, Sang-Ho Choi², Yee Gyung Kwak³, Jin-Won Chung¹, Eun Joo Choo⁴, Kye-Hyung Kim⁵, Na Ra Yun⁶, Shinwon Lee⁷, Ki Tae Kwon⁷, Jae-Hyun Cho⁸, Nam Joong Kim⁹

¹Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

²Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.

³Department of Internal Medicine, Inje University College of Medicine, Busan, Korea.

⁴Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.

⁵Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.

⁶Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Korea.

⁷Division of Infectious Diseases, Daegu Fatima Hospital, Daegu, Korea.

⁸Department of Internal Medicine, National Police Hospital, Seoul, Korea.

⁹Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Correspondence to Sang-Ho Choi, M.D. Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul 138-736, Korea. Tel: +82-2-3010-3304, Fax: +82-2-3010-6970, sangho@amc.seoul.kr

Received 25 January 2012 Revised 8 May 2012 Accepted 22 May 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Necrotizing fasciitis (NF) is an infrequent but potentially lethal infection characterized by rapid progressive destruction of fascia and fat, concomitant systemic toxicity, and high fatality. In spite of the clinical significance of NF, only limited data is available regarding the clinical characteristics of patients with NF in Korea.

Materials and Methods

We retrospectively reviewed the medical records of patients who had been diagnosed as community-acquired NF in 9 centers of the Republic of Korea between January 2000 and November 2010.

Results

During the study period, a total of 103 patients had a community-acquired NF. Of sixty six cases with causative microorganisms identified, the majority (55, 83.3%) had monomicrobial infections. Whereas streptococci were the most common cause of NF in patients without underlying diseases (16/24, 66.7%), variable organisms, such as staphylococci, streptococci, Enterobacteriaceae, and non-fermentative Gram-negative bacilli were causative organisms of NF in patients with underlying diseases. The majority of patients with NF caused by Vibrio vulnificus or Aeromonas hydrophila (7/9, 77.8%) had liver cirrhosis or alcoholism. Surgery to counteract NF was performed in 60.2% of patients with NF (62/102), and mean time to surgery was 3 days. In-hospital mortality was observed in 21 of 99 patients with available data (21.2%). In multivariate analysis, the presence of solid tumors (adjusted OR [aOR]=63.88, 95% CI=2.58-1580.61, P=0.011), shock (aOR= 24.19, 95% CI=2.00-292.19, P=0.012), bacteremia (aOR=87.53, 95% CI=3.99-1921.46, P=0.005), and Gram-negative bacilli infections (aOR=437.11, 95% CI=4.67-40956.82, P=0.009) were associated with in-hospital mortality.

Conclusions

Streptococci were predominant causative organisms of community-acquired NF in patients without underlying diseases. However, in patients with underlying diseases, variable organisms such as staphylococci, streptococci, Enterobacteriaceae, or non-fermentative Gram-negative bacilli were isolated. NF caused by V. vulnificus or A. hydrophila occurred frequently in patients with liver cirrhosis or alcoholism.

Keywords: Necrotizing fasciitis

Figures and Tables

Table 1

Clinical Characteristics of Patients with Community-acquired Necrotizing Fasciitis

Table 2

Identified Causative Organisms in Patients with Community-acquired Necrotizing Fasciitis

^aStreptococcus pneumoniae (1), group F streptococcus (1), group D streptococcus (1), and Viridans streptococci (3).

^bProteus vulgaris (1), Proteus mirabilis (1), and Enterobacter cloacae (1).

^cPropionibacterium acnes (1), Clostridium spp. (1), and Veillonella (1).

Table 3

Clinical and Laboratory Characteristics of Patients with Community-acquired Necrotizing Fasciitis Who Died or Survived after Admission

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