title: The microbiological profile and presence of bloodstream infection influence mortality rates in necrotizing fasciitis.
abstract: BACKGROUND
  Necrotizing fasciitis (NF) is a life threatening infectious disease with a high mortality rate. We carried out a microbiological characterization of the causative pathogens. We investigated the correlation of mortality in NF with bloodstream infection and with the presence of co-morbidities.
  
  
  METHODS
  In this retrospective study, we analyzed 323 patients who presented with necrotizing fasciitis at two different institutions. Bloodstream infection (BSI) was defined as a positive blood culture result. The patients were categorized as survivors and non-survivors. Eleven clinically important variables which were statistically significant by univariate analysis were selected for multivariate regression analysis and a stepwise logistic regression model was developed to determine the association between BSI and mortality.
  
  
  RESULTS
  Univariate logistic regression analysis showed that patients with hypotension, heart disease, liver disease, presence of Vibrio spp. in wound cultures, presence of fungus in wound cultures, and presence of Streptococcus group A, Aeromonas spp. or Vibrio spp. in blood cultures, had a significantly higher risk of in-hospital mortality. Our multivariate logistic regression analysis showed a higher risk of mortality in patients with pre-existing conditions like hypotension, heart disease, and liver disease. Multivariate logistic regression analysis also showed that presence of Vibrio spp in wound cultures, and presence of Streptococcus Group A in blood cultures were associated with a high risk of mortality while debridement > = 3 was associated with improved survival.
  
  
  CONCLUSIONS
  Mortality in patients with necrotizing fasciitis was significantly associated with the presence of Vibrio in wound cultures and Streptococcus group A in blood cultures.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, No,6, W, Sec,, Jiapu Rd,, Puzih City, Chiayi County 613, Taiwan.
authors.forename: I-Chuan
authors.initials: IC
authors.lastname: Chen
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Li
authors.forename: Yu-Cheng
authors.initials: YC
authors.lastname: Hong
authors.forename: Shian-Sen
authors.initials: SS
authors.lastname: Shie
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Fann
authors.forename: Cheng-Ting
authors.initials: CT
authors.lastname: Hsiao
mesh_terms: D000328:Adult; D000368:Aged; D058491:Bacterial Load / Q000379:methods / Q000502:physiology; D015331:Cohort Studies; D019115:Fasciitis, Necrotizing / Q000097:blood* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012189:Retrospective Studies