Background
Methods
Patients
Treatments and clinical parameters
Statistical analyses
Results
Clinical characteristics and presentation of patients with monobacterial necrotizing fasciitis
Gram positive pathogen (n = 11) | Gram Negative pathogen (n = 35) | p value | |
---|---|---|---|
Age | 59 (34, 72) | 64(22, 85) | 0.138 |
Gender(Male/Female) | 9/2 | 26/9 | 1.000 |
Involved region | |||
Upper extremity | 5 (45.5) | 10 (28.6) | 0.462 |
Lower extremity | 6 (54.5) | 25 (71.4) | |
TiOA(day) | 7.18 (2, 14) | 2.43 (0.5, 14)* | < 0.001 |
TiOS(hour) | 25.64 (2, 72) | 11.74 (1, 72)* | 0.046 |
Immunocompromised(DM, liver dysfunction, Chronic renal failure, Malignancy) | 5 (45.5) | 29 (82.8)* | 0.022 |
Comorbidity | |||
DM | 5 (45.5) | 13 (37.1) | 0.728 |
Gout | 5 (45.5) | 2 (5.7)* | 0.005 |
Chronic renal failure (> 1.6 mg/dL) | 2 (18.2) | 7 (20) | 1.000 |
Chronic Liver dysfunction | 1 (9.1) | 18 (51.4)* | 0.016 |
HBV | 0 (0) | 11 (31.4)* | 0.044 |
HCV | 1 (9.1) | 11 (31.4) | 0.241 |
HBV or HCV | 1 (9.1) | 17 (48.6)* | 0.032 |
Liver cirrhosis | 0 | 8 (22.9) | 0.619 |
ICU stay(patient number) | 4 (36.4) | 26 (74.3)* | 0.032 |
Post-operative mechanical ventilation (patient number) | 4 (36.4) | 24 (68.6) | 0.080 |
APACHE II score | 12.9 (3, 21) | 18.9 (2, 34)* | 0.015 |
ICU stay (day) | 2 (0, 7) | 4.3 (0, 16) | 0.077 |
Hospital stay (day) | 35.7 (15, 70) | 35.8 (13, 87) | 0.800 |
Amputation | 0 | 5 (10.9) | 0.317 |
STSG | 5 (45.5) | 21 (60) | 0.494 |
Free flap transfer | 1 (9.1) | 7 (20) | 0.658 |
Mortality | 1(9.1) | 6(17.1) | 1.000 |
Gram positive pathogen (n = 11) | |
---|---|
Staphylococcus aureus | 6(54.5%) |
MSSA | 4 |
MRSA | 2 |
Streptococcus sp. | |
Alpha-hemolytic | 1(9.1%) |
S. viridans
| 1 |
Beta-hemolytic | 4(36.3%) |
S. pyogenes
| 1 |
Group B streptoccus
| 3 |
Gram negative pathogen (n = 35)
| |
Vibrio spp. | 23(66%) |
Vibrio vulnificus | 20 |
Vibrio parahaemolyticus | 2 |
Vibrio cholerae non-O1 | 1 |
Aeromonas spp. | 8(23%) |
Aeromonas hydrophila | 6 |
Aeromonas sobria | 1 |
Aeromonas caviae | 1 |
Kleb.pneumoniae
| 1 |
E. Coli
| 1 |
Pseudomonas Stutzeri
| 1 |
Anaerobes
| |
Prevotella spp. | 1 |
Symptoms and signs | Gram positive pathogen (n = 11) | Gram negative Pathogen (n = 35) | p-value |
---|---|---|---|
Fever (> 38.3°C) | 8 (72.7) | 16 (45.7) | 0.171 |
Hypothemia (< 35°C) | 1 (9.0) | 4(11.4) | 1 |
Pain and tenderness | 11 (100) | 35 (100) | 1 |
Swelling and erythema | 11 (100) | 35 (100) | 1 |
Hemorrhagic bullae | 0 (0) | 15 (42.9)* | 0.009 |
Shock(< 90 mmHg) | 2 (18.2) | 23 (65.7)* | 0.013 |
Inotropic support | 2 (18.2) | 19 (54.3)* | 0.045 |
Laboratory data | Gram positive pathogen (n = 11) | Gram Negative pathogen (n = 35) | p-value |
---|---|---|---|
Total WBC | |||
Leukocytosis(> = 12,000/ul) | 8 (72.7) | 23 (65.7) | 1.000 |
Leukopenia(< = 4,000/ul) | 0 | 4 (11.4) | 0.559 |
Leukocytosis or leukopenia | 8 (72.7) | 27 (77.1) | 1.000 |
Differential count
| |||
Band formation | 9 (81.8) | 33 (94.3) | 0.238 |
Band ≧ 10% | 3 (27.3) | 16 (45.7) | 0.320 |
neutrophilia(> 7,500/ul) | 8 (72.7) | 25 (71.4) | 1.000 |
Lymphocytopenia(< 1,000/ul) | 2 (18.2) | 19 (54.3)* | 0.045 |
Thrombocytopenia(< 150,000/ul) | 0 | 12 (34.3)* | 0.044 |
Bacteremia
| 7 (63.6) | 17 (48.6) | 0.497 |
Hemoglobin(g/dL)
| 12.4 (10.0, 14.1) | 12.6 (7.7, 15.8) | 0.690 |
C-reactive protein (mg/dL)
| 178.0 (50, 373) | 114.0 (24.4, 354) | 0.302 |
Glucose (mg/dL)
| 265.4 (121, 842) | 164.14(91, 436) | 0.065 |
Sodium (meq/L)
| 132.4 (124, 136) | 135.3 (127, 141)* | 0.044 |
Hypoalbuminemia(< 3 g/dL)
| 6 (54.5) | 24 (68.6) | 0.477 |
LRINEC score
| 6.18 (4, 10) | 4.51 (0, 12)* | 0.031 |
Characteristics of surviving and non-surviving patients
Survivors(n = 39) | Deaths (n = 7) | p value | |
---|---|---|---|
Age
| 62 (22, 85) | 68 (55, 78) | 0.668 |
Gender
| |||
Male | 30 (76.9) | 6 (85.7) | 1.000 |
Female | 9 (23.1) | 1 (14.3) | |
Underlying disease
| |||
Viral hepatitis | 13 (33.3) | 5 (71.4) | 0.093 |
Liver cirrhosis | 4 (10.2) | 4 (57.1)* | 0.012 |
Chronic liver dysfunction | 13 (33.3) | 6 (85.7)* | 0.015 |
Diabetes mellitus | 16 (41.0) | 2 (28.6) | 0.688 |
Chronic renal failure | 5 (12.8) | 4 (57.1)* | 0.020 |
Immunocompromised(DM, liver dysfunction, CRF, malignancy)
| 27 (69.2) | 7 (100) | 0.165 |
Pathogens
| |||
Gram positive pathogen | 10 (25.6) | 1 (14.3) | 0.667 |
Gram negative pathogen | 29 (74.4) | 6 (85.7) | |
Involved region
| |||
Upper extremity | 11 (28.2) | 4 (57.1) | 0.193 |
Lower extremity | 28 (71.8) | 3 (42.9) | |
Shock at ER
| 19 (48.7) | 6 (85.7) | 0.106 |
Survival n = 39 | non-survival n = 7 | p-value | |
---|---|---|---|
Total WBC | |||
Leukocytosis(> 12,000/ul) | 27 (69.2) | 4 (57.1) | 0.667 |
Leukopenia(< 4,000/ul) | 2 (5.1) | 2 (28.6) | 0.104 |
Leukocytosis or leukopenia | 29 (74.3) | 6 (85.7) | 0.667 |
Differential count
| |||
Band formation | 35 (89.7) | 7 (100) | 1.000 |
neutrophilia(> 7,500/ul) | 29 (74.3) | 4 (57.1) | 0.385 |
lymphocytopenia(< 1,000/ul) | 16 (41.0) | 5 (71.4) | 0.220 |
Thrombocytopenia(< 150,000/ul) | 7 (17.9) | 5 (71.4) | 0.009 |
Hemoglobin(g/dL) | 12.6 (7.7, 15.8) | 12.4 (10.0, 14.7) | 0.866 |
C-reactive protein (mg/dL)
| 135 (50, 373) | 97 (63, 227) | 0.915 |
Glucose (mg/dL)
| 194.9 (90, 842) | 152 (105, 264) | 0.667 |
Sodium (meq/L)
| 134.6(124, 141) | 134.4 (127, 140) | 0.988 |
Creatinine > 1.6 mg/dL
| 5 (12.8) | 4 (57.1)* | 0.020 |
Hypoalbuminemia(< 3 g/dL)
| 22 (56.4) | 7 (100)* | 0.036 |
LRINEC score
| 5.1 (0, 12) | 3.7 (0, 70 | 0.217 |
APACHE II | 16.9 (2, 34) | 21.3 (17, 27) | 0.090 |
ICU stay (patient numbers) | 23 (59.0) | 7 (100) | 0.078 |
post-OP ventilator (patient numbers) | 21 (53.8) | 7 (100)* | 0.032 |
ICU stay (day) | 2.5 (0, 16) | 10.3 (7, 14)* | < 0.001 |
Hospital stay(day) | 36 (13, 87) | 34.6 (14, 79) | 0.635 |