Monomicrobial gram-negative necrotizing fasciitis: An uncommon but fatal syndrome

Area of Science:

• Infectious Diseases
• Microbiology
• Surgical Infections

Background:

• Necrotizing fasciitis is a severe soft tissue infection.
• Monomicrobial infections represent a significant portion of necrotizing fasciitis cases.
• Understanding differences between gram-negative and gram-positive necrotizing fasciitis is crucial for treatment.

Purpose of the Study:

• To characterize patients with monomicrobial gram-negative necrotizing fasciitis.
• To compare outcomes and risk factors between gram-negative and gram-positive necrotizing fasciitis.
• To identify predictors of mortality in necrotizing fasciitis patients.

Main Methods:

• Retrospective analysis of 115 patients with community-acquired necrotizing fasciitis from three Korean university hospitals.
• Categorization of infections into gram-negative and gram-positive monomicrobial groups.
• Multivariable logistic regression analysis to identify factors associated with 30-day mortality.

Main Results:

• Of 115 patients, 67 (58%) had monomicrobial infections (31 gram-negative, 36 gram-positive).
• Escherichia coli was the most common pathogen in the gram-negative group.
• Gram-negative necrotizing fasciitis patients had higher rates of liver cirrhosis (39% vs. 14%, P=0.02).
• Liver cirrhosis, antibiotic-only treatment, and low albumin levels were associated with increased 30-day mortality.

Conclusions:

• Gram-negative necrotizing fasciitis is frequently associated with liver cirrhosis.
• Gram-negative necrotizing fasciitis appears to have poorer outcomes compared to gram-positive infections.
• Risk factors for mortality include liver cirrhosis, lack of surgical intervention, and hypoalbuminemia.