Necrotizing fasciitis in three university hospitals in Korea: a change in causative microorganisms and risk factors of mortality during the last decade.
BACKGROUND
Necrotizing fasciitis is a life-threatening infectious disease with rapidly progressive involvement of the affected site. Because of the high mortality rate of this disease, early diagnosis, surgical exploration, and administration of appropriate antibiotics are necessary. The present study aimed to further review the changes in the clinical and microbiological characteristics of necrotizing fasciitis using patients' medical records from consecutive databases of 3 hospitals in Korea.


METHODS
In this study, we retrospectively reviewed the medical records of patients with necrotizing fasciitis who were clinically diagnosed between May 2001 and February 2012 in 3 university hospitals in Korea. In total, the data of 83 patients were analyzed, including those of 20 patients from our previous study in 2006. An organism found in a blood culture or surgical specimen was regarded as a causative organism.


RESULTS
Of the 83 patients, 68(81.9%) had community-acquired infections. Ninety microorganism species were indentifed by culture. Streptococcus was the most commonly identified pathogen. Non-fermentative gram-negative bacteria and Candida species have recently emerged, especially in immunocompromised hosts.


CONCLUSIONS
Gram-positive organisms are still the most common pathogens of necrotizing fasciitis. However in our study, various gram-negative bacteria with different levels of susceptibility to antibiotics, as well as Candida species, were responsible for the necrotizing fasciitis. Initial empirical antimicrobial agents for necrotizing fasciitis should be considered depending on the individual patient's condition.
Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea.
Shi Nae
SN
Yu
Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea.
Tae Hyong
TH
Kim
Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea.
Eun Jung
EJ
Lee
Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
Eun-Joo
EJ
Choo
Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
Min Hyok
MH
Jeon
Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
Yung Gyu
YG
Jung
Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
Tae Jin
TJ
Kim
Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea.
In Ki
IK
Mun
Biostatistical Consulting Unit, Soonchunhyang University Medical Center, Seoul, Korea.
Ji Sung
JS
Lee
Necrotizing fasciitis; Skin and soft tissue infection