Necrotizing fasciitis in patients with liver cirrhosis: predominance of monomicrobial Gram-negative bacillary infections

Ching Chi Lee, Chih Hsien Chi, Nan Yao Lee, Hsin Chun Lee, Chung Lin Chen, Po Lin Chen, Chia Ming Chang, Chi Jung Wu, Nai Ying Ko, Ming Che Tsai, Wen Chien Ko

Research output: Contribution to journalArticlepeer-review

50 Citations (Scopus)

Abstract

Necrotizing fasciitis (NF), a rare but severe infection, usually occurs in individuals with underlying chronic illness, but its clinical presentation among cirrhotic patients is infrequently discussed. Forty-two cirrhotic patients with 47 episodes of NF between 1995 and 2006 were analyzed. Their mean age was 55.6 years, with male preponderance (34 patients, 81%). Lower extremities were mainly involved (70%). Of 42 episodes with identified pathogens, 41 (97%) were monomicrobial infections and were caused mainly by Gram-negative rods (GNBs) (32, 76%), including Vibrio (15, 36%), Klebsiella (9, 21%), and Aeromonas spp. (6, 14%). As compared with NF caused by Gram-positive cocci (GPCs), NF caused by GNBs tended to have concurrent bacteremia (81% versus 50%, P = 0.09) and initially presented with septic shock (75% versus 30%, P = 0.02). However, the in-hospital mortality rate was similar for NF caused by GNBs and GPCs (34% versus 30%, P = 1.00). In multivariate analyses, higher sepsis-related organ failure assessment scores (>8) and Child-Pugh class C at initial presentation were independently associated with poor prognoses.

Original languageEnglish
Pages (from-to)219-225
Number of pages7
JournalDiagnostic Microbiology and Infectious Disease
Volume62
Issue number2
DOIs
Publication statusPublished - 2008 Oct

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

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