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

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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 1

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Necrotizing Fasciitis
Liver Cirrhosis
Gram-Positive Cocci
Infection
Organ Dysfunction Scores
Aeromonas
Vibrio
Klebsiella
Septic Shock
Bacteremia
Hospital Mortality
Lower Extremity
Sepsis
Chronic Disease
Multivariate Analysis
Mortality

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

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title = "Necrotizing fasciitis in patients with liver cirrhosis: predominance of monomicrobial Gram-negative bacillary infections",
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.",
author = "Lee, {Ching Chi} and Chih-Hsien Chi and Nan-Yao Lee and Lee, {Hsin Chun} and Chung-Lin Chen and Po-Lin Chen and Chia-Ming Chang and Wu, {Chi Jung} and Nai-Ying Ko and Tsai, {Ming Che} and Wen-Chien Ko",
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T1 - Necrotizing fasciitis in patients with liver cirrhosis

T2 - predominance of monomicrobial Gram-negative bacillary infections

AU - Lee, Ching Chi

AU - Chi, Chih-Hsien

AU - Lee, Nan-Yao

AU - Lee, Hsin Chun

AU - Chen, Chung-Lin

AU - Chen, Po-Lin

AU - Chang, Chia-Ming

AU - Wu, Chi Jung

AU - Ko, Nai-Ying

AU - Tsai, Ming Che

AU - Ko, Wen-Chien

PY - 2008/10/1

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N2 - 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.

AB - 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.

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