Details

Autor(en) / Beteiligte

• Tsitsilonis, Serafim
• Druschel, Claudia
• Wichlas, Florian
• Haas, Norbert P.
• Schwabe, Philipp
• Bail, Hermann-Josef
• Schaser, Klaus-Dieter

Titel

Necrotizing fasciitis: is the bacterial spectrum changing?

Ist Teil von

• Langenbeck's archives of surgery, 2013, Vol.398 (1), p.153-159

Ort / Verlag

Berlin/Heidelberg: Springer-Verlag

Erscheinungsjahr

2013

Link zum Volltext

Quelle

SpringerLink (Online service)

Beschreibungen/Notizen

• Purpose Necrotizing fasciitis (NF) is a rare, but potentially fatal pathology. The aim of the present study was to identify the population characteristics of the NF patients, the responsible bacteria, and the differences between survivors and nonsurvivors. Methods In this retrospective case–control study, all patients with NF from January 1, 2005, to December 31, 2010, treated in an academic level 1 trauma center, were identified, and their medical records were reviewed. Results The mortality rate of the 24 identified patients was 20.8 %. The majority of the infections (54.2 %) (13/24) were monomicrobial. Hemolytic Streptococcus of group A (25 %) and methicillin-resistant Staphylococcus aureus (20.8 %) were the commonest germs. The mean number of comorbidities was 3.62 (standard deviation (SD) 3.58). Diabetes mellitus, cardiovascular disease, and immunosuppression were the commonest. Mean number of operations was 8.1 (SD 4.7). Five patients (20.8 %) developed a disseminated intravascular coagulation (DIC); all of them died. Nonsurvivors, who presented with deteriorated coagulation factors, developed a DIC ( p  < 0.001) and received more often antibiotic monotherapy (ampicillin/sulbactam) as initial empirical therapy ( p  < 0.001). Conclusions The present study suggests a shift of the bacterial spectrum towards monomicrobial infections with multiresistant bacteria. The early recognition of high-risk patients and the aggressive surgical treatment with at least double-schema antibiotic therapy are of outmost importance.