title: Synchronous multifocal necrotizing fasciitis prognostic factors: a retrospective case series study in a single center.
abstract: OBJECTIVE
  No reports have been published on synchronous multifocal necrotizing fasciitis (SMNF), a multifocal presence of necrotizing fasciitis in different extremities. We evaluated the clinical characteristics and outcomes of SMNF.
  
  
  METHODS
  Eighteen patients (14 men, 4 women; mean age: 59 years) diagnosed with SMNF of the extremities between January 2004 to December 2012 were enrolled and evaluated.
  
  
  RESULTS
  Vibrio species were the most commonly (78%; n = 14) isolated; others were two cases (11%) of Aeromonas spp., one case (6%) of group A β-hemolytic streptococcus, and one case of coagulase-negative staphylococcus. SMNF was in the bilateral lower limbs (72%; n = 13), bilateral upper limbs (17%; n = 3), and one patient with one upper and one lower limb (11%). Non-surviving patients had more bilateral lower limb involvement and thrombocytopenia.
  
  
  CONCLUSIONS
  Most patients with SMNF were male and had bilateral lower limb and marine Gram-negative bacteria involvement. The mortality of SMNF remained extremely high in patients with involvement of bilateral lower limb and initial thrombocytopenia.
authors: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan.|Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Ching-Yu
authors: CY
authors: Lee
authors: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan.
authors: Yen-Yao
authors: YY
authors: Li
authors: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Tsan-Wen
authors: TW
authors: Huang
authors: Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors: Tsung-Yu
authors: TY
authors: Huang
authors: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan.|Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Wei-Hsiu
authors: WH
authors: Hsu
authors: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan.
authors: Yao-Hung
authors: YH
authors: Tsai
authors: Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors: Jou-Chen
authors: JC
authors: Huang
authors: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West Sec., Jiapu Road, Puzi City, Chiayi, 613, Taiwan. orthoejaca@gmail.com.|Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. orthoejaca@gmail.com.
authors: Kuo-Chin
authors: KC
authors: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019115:Fasciitis, Necrotizing / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Multifocal; Necrotizing fasciitis; Prognostic factors; Synchronous