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Necrotizing fasciitis, causative agents and management: a five-year retrospective study in two tertiary care
Sanjiv Rampal1, Sandra Maniam2, Poh Ying Lim3
1Department of Orthopaedic, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia.
Purpose:
Necrotizing fasciitis (NF) is a rapidly progressive inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues. The severity of the disease depends on the virulence of the organism and host immunity. There is a paucity of reports on the prevalence of NF causing pathogens and management.
Methods:
Retrospective data of patients treated for NF were collected from two tertiary care hospitals in Central Malaysia between January 2014 and December 2018.
Results:
A total of 469 NF patients were identified. More than half of the NF patients were males (n = 278; 59.28%). The highest number of cases was found among age groups between 30 and 79, with mean age of 56.17. The majority of the NF cases (n = 402; 85.72%) were monomicrobial. Streptococcus spp. (n = 89; 18.98%), Pseudomonas aeruginosa (n = 63; 13.44%) and Staphylococcus spp. (n = 61; 13.01%) were identified as the top three microorganisms isolated. Among the 469 NF cases, 173 (36.8%) were amputated or dead while 296 (63.1%) recovered. Proteus spp. (n = 19; 12.93%), Klebsiella pneumoniae (n = 18; 12.24%) and Escherichia coli (n = 14; 9.52%) were associated with all types of amputations. The most common antibiotic prescribed was unasyn (n = 284; 60.56%), followed by clindamycin (n = 56; 11.94%) and ceftazidime (n = 41; 8.74%). A total of 239 (61.8%) recovered while 148 (38.2%) were either amputated or dead when managed with the unasyn, clindamycin or ceftazidime.
Conclusion:
This study represents the largest NF cases series in Malaysia highlighting the causative agents and management.
Insights
Necrotizing fasciitis (NF) is a severe infection. This study identified common pathogens like Streptococcus spp. and Staphylococcus spp., with 36.8% of patients experiencing amputation or death.
Area of Science:
- Infectious Diseases
- Microbiology
- Surgery
Background:
- Necrotizing fasciitis (NF) is a severe, rapidly progressing infection affecting fascia and subcutaneous tissues.
- Disease severity is influenced by pathogen virulence and host immunity.
- Limited data exists on NF prevalence, causative agents, and management strategies.
Purpose of the Study:
- To investigate the prevalence of pathogens causing necrotizing fasciitis.
- To analyze management strategies and outcomes for NF patients.
- To provide insights into the largest series of NF cases in Malaysia.
Main Methods:
- A retrospective analysis of 469 NF patients treated in two Malaysian tertiary care hospitals from 2014 to 2018.
- Identification of causative microorganisms and analysis of patient demographics and outcomes.
- Review of antibiotic treatments administered and their correlation with patient recovery or adverse events.
Main Results:
- The majority of NF cases (85.72%) were monomicrobial, with Streptococcus spp., Pseudomonas aeruginosa, and Staphylococcus spp. being the most common pathogens.
- 36.8% of patients experienced amputation or death.
- Proteus spp., Klebsiella pneumoniae, and Escherichia coli were associated with amputations.
- Unasyn, clindamycin, and ceftazidime were the most frequently prescribed antibiotics.
Conclusions:
- This study provides a comprehensive overview of NF epidemiology and management in Malaysia.
- Understanding common pathogens and treatment outcomes is crucial for improving patient care.
- Further research is needed to optimize treatment protocols for necrotizing fasciitis.
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