Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chia-Yi, 6, West Sec, Chia-Pu Rd, Putz City, Chia-Yi, 613, Taiwan.
Int J Infect Dis. 2012 Mar;16(3):e159-65. doi: 10.1016/j.ijid.2011.11.001. Epub 2011 Dec 9.
Necrotizing fasciitis is a true surgical emergency. This study was undertaken to determine whether clinical indicators could be used to initiate early surgery, and to compare the characteristics observed on initial examination of necrotizing fasciitis in patients who died and those who survived.
We retrospectively reviewed the medical records of 143 patients with surgically confirmed necrotizing fasciitis of the extremities over a period of 3.5 years at a tertiary hospital of southwest Taiwan. Differences in mortality, patient characteristics, laboratory findings, and hospital course were compared between patients who died and those who survived, and between patients with Gram-positive infections and those with Gram-negative infections.
A patient with a fungal infection died. Nine of the 58 patients in the Gram-positive group (15.5%) and 12 of the 60 cases in the Gram-negative group (20%) died. Hence a total of 22 patients died, giving a mortality rate of 15.4%. Hypotension, lower counts of total and segmented leukocytes, higher counts of banded leukocytes, and lower levels of serum albumin were significantly associated with mortality. Monomicrobial infections had a stake of 70.6%, and Vibrio spp were the predominant causative agents (26.6%).
Hypotensive shock, severe hypoalbuminemia, and increased counts of banded leukocytes can be considered the clinical and laboratory risk indicators to initiate early surgery and to predict mortality for all types of necrotizing fasciitis. The clinical characteristics of Gram-negative infections were more fulminant than those of Gram-positive infections.
坏死性筋膜炎是一种真正的外科急症。本研究旨在确定是否可以使用临床指标来启动早期手术，并比较在西南台湾一家三级医院接受手术确认的四肢坏死性筋膜炎患者的初始检查中观察到的死亡患者和存活患者的特征。
我们回顾性分析了 3.5 年间在西南台湾一家三级医院接受手术确认的 143 例四肢坏死性筋膜炎患者的病历。比较了死亡患者和存活患者、革兰氏阳性感染患者和革兰氏阴性感染患者之间的死亡率、患者特征、实验室检查结果和住院过程的差异。
一名真菌感染患者死亡。革兰氏阳性组 58 例患者中有 9 例（15.5%），革兰氏阴性组 60 例中有 12 例（20%）死亡。因此，共有 22 例患者死亡，死亡率为 15.4%。低血压、总白细胞和分叶白细胞计数较低、带状白细胞计数较高以及血清白蛋白水平较低与死亡率显著相关。单一微生物感染占 70.6%，弧菌属是主要的病原体（26.6%）。
低血压性休克、严重低白蛋白血症和带状白细胞计数增加可被视为启动早期手术和预测所有类型坏死性筋膜炎患者死亡率的临床和实验室风险指标。革兰氏阴性感染的临床特征比革兰氏阳性感染更为严重。
