Awsakulsutthi Surajit
Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
J Med Assoc Thai. 2010 Dec;93 Suppl 7:S246-53.
Necrotizing fasciitis is a rapidly progressive soft tissue infection. Clinicalfeatures and microbial knowledge will help reduce mortality and morbidity from delayed diagnosis and treatment.
From January 2004 to December 2009, records of 222 necrotizing fasciitis patients were reviewed for the study. The following data were collected and recorded: age, sex, location of lesion, inciting event, clinical manifestation, culture and sensitivity and procedures.
The male-to-female ratio was 1.4:1 with 56.3 years mean age. The most of the occupations were elderly who stay at home and laborers. The highest incidence rate was during the raining seasons. The most common infection site was at the lower extremity with unknown inciting event. A common underlying disease was diabetes. The major complains presented was skin lesion, fever with chill, conscious change, gastrointestinal symptom. Examination revealed erythematous and swelling skin lesion (100%), fever (50.9)%, hypotension blood pressure (32.4%). Positive wound culture isolation was 55.9% and in blood culture was 48%. Dominant gram negative bacteria (71.98%) were in wound culture but gram positive bacteria (51.28%) were dominant in blood culture. Polymicrobial isolates in wound culture was 48% and in blood culture was 6%. The average 2.5 procedures were debridement (33.8%), skin graft coverage (59.9%), amputation (15.4%). Mortality rate was 5.9% that 46.2% were diabetes.
Gram negative organisms were predominant wound isolates whereas gram positive organisms were predominant blood isolates. With high polymicrobial isolation, clinical manifestation can be described as necrotizing fasciitis type I. The elderly and diabetic patients were at risk. Early diagnosis is important in patients with fever, toxicity and erythematous swelling skin findings. The hallmarks of treatment are prompt surgical opening and debridement to get rid of the source of infection and broad-spectrum antibiotics treatment administered.
坏死性筋膜炎是一种进展迅速的软组织感染。临床特征和微生物学知识有助于降低因诊断和治疗延迟导致的死亡率和发病率。
回顾2004年1月至2009年12月期间222例坏死性筋膜炎患者的记录用于本研究。收集并记录以下数据：年龄、性别、病变部位、诱发事件、临床表现、培养及药敏结果和治疗程序。
男女比例为1.4:1，平均年龄56.3岁。大多数职业为居家老年人和劳动者。发病率最高的季节是雨季。最常见的感染部位是下肢，诱发事件不明。常见的基础疾病是糖尿病。主要症状为皮肤病变、发热伴寒战、意识改变、胃肠道症状。检查发现皮肤病变处有红斑和肿胀（100%）、发热（50.9%）、低血压（32.4%）。伤口培养阳性率为55.9%，血培养阳性率为48%。伤口培养中占主导的革兰阴性菌（71.98%），但血培养中革兰阳性菌占主导（51.28%）。伤口培养中多微生物分离株占48%，血培养中占6%。平均进行2.5次手术，清创术（33.8%）、皮肤移植覆盖（59.9%）、截肢术（15.4%）。死亡率为5.9%，其中46.2%为糖尿病患者。
革兰阴性菌是伤口分离株中的主要类型，而革兰阳性菌是血培养分离株中的主要类型。多微生物分离率高，临床表现可描述为I型坏死性筋膜炎。老年人和糖尿病患者有风险。对于有发热、中毒症状及皮肤红斑肿胀表现的患者，早期诊断很重要。治疗的关键是迅速进行手术切开和清创以消除感染源，并给予广谱抗生素治疗。
