title: Prognostic factors and monomicrobial necrotizing fasciitis: gram-positive versus gram-negative pathogens.
abstract: BACKGROUND
  Monomicrobial necrotizing fasciitis is rapidly progressive and life-threatening. This study was undertaken to ascertain whether the clinical presentation and outcome for patients with this disease differ for those infected with a gram-positive as compared to gram-negative pathogen.
  
  
  METHODS
  Forty-six patients with monomicrobial necrotizing fasciitis were examined retrospectively from November 2002 to January 2008. All patients received adequate broad-spectrum antibiotic therapy, aggressive resuscitation, prompt radical debridement and adjuvant hyperbaric oxygen therapy. Eleven patients were infected with a gram-positive pathogen (Group 1) and 35 patients with a gram-negative pathogen (Group 2).
  
  
  RESULTS
  Group 2 was characterized by a higher incidence of hemorrhagic bullae and septic shock, higher APACHE II scores at 24 h post-admission, a higher rate of thrombocytopenia, and a higher prevalence of chronic liver dysfunction. Gouty arthritis was more prevalent in Group 1. For non-survivors, the incidences of chronic liver dysfunction, chronic renal failure and thrombocytopenia were higher in comparison with those for survivors. Lower level of serum albumin was also demonstrated in the non-survivors as compared to those in survivors.
  
  
  CONCLUSIONS
  Pre-existing chronic liver dysfunction, chronic renal failure, thrombocytopenia and hypoalbuminemia, and post-operative dependence on mechanical ventilation represent poor prognostic factors in monomicrobial necrotizing fasciitis. Patients with gram-negative monobacterial necrotizing fasciitis present with more fulminant sepsis.
authors.affiliation: Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia Yi, 6 West Section Chia Pu Road, Chia Yi Hsien 613, Taiwan.
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Lee
authors.forename: Liang-Tseng
authors.initials: LT
authors.lastname: Kuo
authors.forename: Kuo-Ti
authors.initials: KT
authors.lastname: Peng
authors.forename: Wei-Hsiu
authors.initials: WH
authors.lastname: Hsu
authors.forename: Tsan-Wen
authors.initials: TW
authors.lastname: Huang
authors.forename: Ying-Chao
authors.initials: YC
authors.lastname: Chou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019115:Fasciitis, Necrotizing / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification / Q000502:physiology*; D006094:Gram-Positive Bacteria / Q000302:isolation & purification / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013534:Survival; D055815:Young Adult