title: Necrotizing fasciitis: is the bacterial spectrum changing?
abstract: OBJECTIVE
  Necrotizing fasciitis (NF) is a rare, but potentially fatal pathology. The aim of the present study was to identify the population characteristics of the NF patients, the responsible bacteria, and the differences between survivors and nonsurvivors.
  
  
  METHODS
  In this retrospective case-control study, all patients with NF from January 1, 2005, to December 31, 2010, treated in an academic level 1 trauma center, were identified, and their medical records were reviewed.
  
  
  RESULTS
  The mortality rate of the 24 identified patients was 20.8 %. The majority of the infections (54.2 %) (13/24) were monomicrobial. Hemolytic Streptococcus of group A (25 %) and methicillin-resistant Staphylococcus aureus (20.8 %) were the commonest germs. The mean number of comorbidities was 3.62 (standard deviation (SD) 3.58). Diabetes mellitus, cardiovascular disease, and immunosuppression were the commonest. Mean number of operations was 8.1 (SD 4.7). Five patients (20.8 %) developed a disseminated intravascular coagulation (DIC); all of them died. Nonsurvivors, who presented with deteriorated coagulation factors, developed a DIC (p < 0.001) and received more often antibiotic monotherapy (ampicillin/sulbactam) as initial empirical therapy (p < 0.001).
  
  
  CONCLUSIONS
  The present study suggests a shift of the bacterial spectrum towards monomicrobial infections with multiresistant bacteria. The early recognition of high-risk patients and the aggressive surgical treatment with at least double-schema antibiotic therapy are of outmost importance.
authors: Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. serafeim.tsitsilonis@charite.de
authors: Serafim
authors: S
authors: Tsitsilonis
authors: Claudia
authors: C
authors: Druschel
authors: Florian
authors: F
authors: Wichlas
authors: Norbert P
authors: NP
authors: Haas
authors: Philipp
authors: P
authors: Schwabe
authors: Hermann-Josef
authors: HJ
authors: Bail
authors: Klaus-Dieter
authors: KD
authors: Schaser
mesh_terms: D000328:Adult; D000368:Aged; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000382:microbiology* / Q000401:mortality / Q000601:surgery*; D001431:Bacteriological Techniques; D002177:Candidiasis / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D016022:Case-Control Studies; D015897:Comorbidity; D003646:Debridement / Q000379:methods; D024901:Drug Resistance, Multiple, Bacterial; D019115:Fasciitis, Necrotizing / Q000382:microbiology* / Q000401:mortality / Q000601:surgery*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D009894:Opportunistic Infections / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D013290:Streptococcal Infections / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D013297:Streptococcus pyogenes; D013407:Sulbactam / Q000627:therapeutic use; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000667:Ampicillin; D013407:Sulbactam