Recent trend of necrotizing fasciitis in taiwan: Focus on monomicrobial Klebsiella pneumoniae necrotizing fasciitis
Journal
Clinical Infectious Diseases
Journal Volume
55
Journal Issue
7
Pages
930-939
Date Issued
2012
Author(s)
Abstract
Background.Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft-tissue infection that is traditionally caused by group A Streptococcus (GAS) or mixed aerobic/anaerobic bacteria. Monomicrobial Klebsiella pneumoniae NF (KP-NF) has been reported since 1996 but has not yet been systematically studied.Methods.We retrospectively studied consecutive NF cases treated at a university hospital in Taiwan during 1997-2010 and investigated the clinical characteristics and outcomes associated with monomicrobial KP-NF, using monomicrobial GAS-NF as a reference. We also analyzed the virulence gene profiles of the isolated K. pneumoniae strains.Results.Of 134 NF cases, 88 were monomicrobial, of which the most common pathogens were GAS (n = 16) and K. pneumoniae (n = 15). Monomicrobial KP-NF entailed a moderate risk of limb loss (20 vs 25; P = 1.000) and high mortality (47 vs 19; P =. 135), and it was more likely to involve bacteremia (80 vs 31; P =. 011), concomitant distant abscesses (27 vs 0; P =. 043), and underlying immunocompromising conditions (100 vs 63; P =. 018), compared with GAS-NF. The isolated K. pneumoniae strains (n = 10) were of capsular polysaccharides genotype K1 (n = 4), K54/K20/K5 (n = 4), K2 (n = 1), and K16 (n = 1). All strains carried rmpA, iucABCDiutA, and iroA. Genotype K1 strains had a significantly higher risk of concomitant distant abscesses, compared with non-K1 strains (75 vs 0; P =. 033).Conclusions.K. pneumoniae has become a common pathogen of monomicrobial NF in Taiwan. Physicians treating patients with monomicrobial KP-NF should be aware of the risk of concomitant distant abscesses, particularly in cases caused by genotype K1. ? The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
SDGs
Other Subjects
amikacin; amoxicillin plus clavulanic acid; ampicillin; cefazolin; cefepime; cefotaxime; cefoxitin; ceftriaxone; ciprofloxacin; clavulanic acid; flomoxef; gentamicin; imipenem; meropenem; oxacillin; polysaccharide; sulbactam; ticarcillin; tobramycin; abscess; adult; aged; antibiotic resistance; antibiotic sensitivity; article; bacteremia; bacterial virulence; below knee amputation; debridement; fasciotomy; female; genotype; group A streptococcal infection; human; immunocompromised patient; incision; Klebsiella pneumoniae; Klebsiella pneumoniae infection; major clinical study; male; mortality; necrotizing fasciitis; nonhuman; nucleotide sequence; priority journal; retrospective study; split thickness skin graft; Streptococcus group A; surgical drainage; Taiwan; Adult; Aged; DNA, Bacterial; Fasciitis, Necrotizing; Female; Hospitals, University; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Molecular Sequence Data; Prevalence; Retrospective Studies; Sequence Analysis, DNA; Streptococcal Infections; Streptococcus pyogenes; Survival Analysis; Taiwan; Treatment Outcome; Virulence Factors
Type
journal article