Characteristics of necrotizing fasciitis in three university hospitals in Korea

Lee, Min Woo; Kim, Tae Hyong; Choo, Eun Joo; Kang, Jee Heon; Kim, Do Whan; Kim, Dong Kyun; Park, Sang Wook; An, Ji Hoon; Yoon, Hyung Geun; Eo, Sung June; Lee, Gun Wha; Lee, Young Ha; Lee, Joon Young; Cheon, Kang Il

Abstract

BACKGROUND: Necrotizing fasciitis is a life threatening severe soft tissue infection primarily involving the fascia and the subcutaneous tissue with thrombosis of the cutaneous microcirculation. The purpose of the study was to analyze the microbiological and clinical characteristics of necrotizing fasciitis in Korea and to suggest adequate antibiotic therapy.
METHODS
We retrospectively reviewed medical records of three Soonchunhyang University Hospitals in Seoul, Bucheon and Cheonan. Patients admitted for skin graft or secondary treatment were excluded. Blood cultures were obtained at the time of admission and pus cultures were obtained at the time of first operative debridement.
RESULTS
Twenty two patients (16 males, 6 females, 16~82 years old, median age: 59 years old) were enrolled for this study. Fourteen pateints underwent surgical treatment and 2 of them died of necrotizing fasciitis. Gram positive organisms were isolated in 13 cases and gram negative organisms were isolated in 11 cases. Third generation cephalosporin resistant gram negative organisms were isolated in 3 cases.
CONCLUSIONS
This study suggest that characteristics of necrotizing fascitis in Korea were; high proportion of aged person, predominance of type 2 necrotizing fascitis and increasing tendency of third generation cephalosporin resistant gram negative bacterial infections. Consequently, initial choice of empirical antibiotics for necrotizing fasciitis should consider 3rd generation cephalosporin resistant gram negative organisms. Prompt surgical debridement and adequate antimicrobial therapy are mandatory for improved survival.