Monomicrobial Klebsiella pneumoniae necrotizing fasciitis: an emerging life-threatening entity

Necrotizing fasciitis (NF) although rare, is a potentially fatal infection. The majority of cases are polymicrobial, although a recent surge has been reported in monomicrobial NF caused by Klebsiella pneumoniae (KP-NF). KP-NF recently accounted for an average of 16% among all pathogens, with highest mortality rate of 60%. This review discusses the important aspects of KP-NF with additional notes on the implications of multidrug resistant infections.

The literature was searched using PubMed. Klebsiella pneumoniae isolated monomicrobially in NF cases was used as the selection criteria.

KP-NF predominates in East Asia with the majority of cases reported from Taiwan alone. Reports from the Western hemisphere are also gradually rising. This infection has invariably presented with underlying predisposing factors occurring mostly in individuals with compromised host immunity. Diabetes, chronic liver disease, and instrumentation are important risk factors. With haematogenous spread more common, multifocal involvement via metastasis is reported. Clinical presentations are usually aggressive with rapid progression despite antimicrobial therapy. It may even present with severe sepsis. Clinicians must be aware of the differential diagnosis of such severe presentations. Emergency surgical explorations and microbiological investigations clinch the diagnosis. Outcomes are not favourable, with a high mortality rate of 40% even after appropriate interventions. Nosocomial KP-NF cases are more fulminant and multidrug resistant with even higher mortality rates (approx. 70%).

KP-NF with its virulent course and high mortality, is an emerging life threat. Clinicians must be aware of its key features. Further comprehensive studies are needed for better insights into the spectrum of this fatal infection.