Necrotizing fasciitis in southeast Taiwan: clinical features, microbiology, and prognosis

Objectives: To determine the spectrum of microorganisms, clinical features, and risk factors of necrotizing fasciitis in southeast Taiwan. Methods: We retrospectively studied patients diagnosed with necrotizing fasciitis and fully treated in our hospital for the period January 1995 to December 2006. Results: The mean age of the patients was 58.2 +/- 14.2 years. The affected anatomical sites were primarily peripheral (91 patients, 85.8%). Sixty patients (56.6%) had a type 1 infection, 17 patients (16.0%) had type 2, and eight patients (7.5%) had type 3. Diabetes mellitus was the most common comorbidity. A single pathogen was identified as the infectious agent in 64 patients (60.4%), multiple pathogens were identified in 21 patients (19.8%), and no organism was identified in 21 patients (19.8%). Streptococcus pyogenes was the most common pathogen. The average hospital stay was 28.0 +/- 23.1 days. Patients received a mean of 2.3 +/- 1.2 debridements, and five patients (4.7%) eventually underwent an amputation. The overall mortality was 17.0%. Predictors of mortality included advanced age, class C liver cirrhosis, ascites, higher serum creatinine, and lower hemoglobin and platelet levels. Conclusions: Monobacterial infections are more common in our patients. Accurate early diagnosis and extensive surgical debridement are essential for a favorable outcome. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.