Necrotizing fasciitis in patients with liver cirrhosis: predominance of monomicrobial Gram-negative bacillary infections.
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.
Lee
Ching-Chi
CC
Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan.
Chi
Chih-Hsien
CH
Lee
Nan-Yao
NY
Lee
Hsin-Chun
HC
Chen
Chung-Lin
CL
Chen
Po-Lin
PL
Chang
Chia-Ming
CM
Wu
Chi-Jung
CJ
Ko
Nai-Ying
NY
Tsai
Ming-Che
MC
Ko
Wen-Chien
WC
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
D003470:Culture Media