title: Necrotizing fasciitis in patients with liver cirrhosis: predominance of monomicrobial Gram-negative bacillary infections.
abstract: Necrotizing fasciitis (NF), a rare but severe infection, usually occurs in individuals with underlying chronic illness, but its clinical presentation among cirrhotic patients is infrequently discussed. Forty-two cirrhotic patients with 47 episodes of NF between 1995 and 2006 were analyzed. Their mean age was 55.6 years, with male preponderance (34 patients, 81%). Lower extremities were mainly involved (70%). Of 42 episodes with identified pathogens, 41 (97%) were monomicrobial infections and were caused mainly by Gram-negative rods (GNBs) (32, 76%), including Vibrio (15, 36%), Klebsiella (9, 21%), and Aeromonas spp. (6, 14%). As compared with NF caused by Gram-positive cocci (GPCs), NF caused by GNBs tended to have concurrent bacteremia (81% versus 50%, P=0.09) and initially presented with septic shock (75% versus 30%, P=0.02). However, the in-hospital mortality rate was similar for NF caused by GNBs and GPCs (34% versus 30%, P=1.00). In multivariate analyses, higher sepsis-related organ failure assessment scores (>8) and Child-Pugh class C at initial presentation were independently associated with poor prognoses.
authors.affiliation: Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan.
authors.forename: Ching-Chi
authors.initials: CC
authors.lastname: Lee
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Chi
authors.forename: Nan-Yao
authors.initials: NY
authors.lastname: Lee
authors.forename: Hsin-Chun
authors.initials: HC
authors.lastname: Lee
authors.forename: Chung-Lin
authors.initials: CL
authors.lastname: Chen
authors.forename: Po-Lin
authors.initials: PL
authors.lastname: Chen
authors.forename: Chia-Ming
authors.initials: CM
authors.lastname: Chang
authors.forename: Chi-Jung
authors.initials: CJ
authors.lastname: Wu
authors.forename: Nai-Ying
authors.initials: NY
authors.lastname: Ko
authors.forename: Ming-Che
authors.initials: MC
authors.lastname: Tsai
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000150:complications / Q000382:microbiology; D001769:Blood / Q000382:microbiology; D003470:Culture Media; D003646:Debridement; D019115:Fasciitis, Necrotizing / Q000150:complications* / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged
chemical_list: D003470:Culture Media