Lin Jiun-Nong, Chang Lin-Li, Lai Chung-Hsu, Lin Hsi-Hsun, Chen Yen-Hsu
Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Emergency and Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
J Emerg Med. 2013 Nov;45(5):781-8. doi: 10.1016/j.jemermed.2013.05.046. Epub 2013 Aug 9.
Group A Streptococcal (GAS) necrotizing fasciitis is a critical emergency. Patients with necrotizing fasciitis principally present to emergency departments (EDs), but most studies are focused on hospitalized patients.
An ED patient-based retrospective study was conducted to investigate the clinical characteristics, associated factors, and outcomes of GAS necrotizing fasciitis in the ED.
Patients visiting the ED from January 2005 through December 2011 with the diagnosis of GAS necrotizing fasciitis were enrolled. All patients with the diagnosis of noninvasive skin and soft-tissue infections caused by GAS were included as the control group.
During the study period, 75 patients with GAS necrotizing fasciitis were identified. Males accounted for 84% of patients. The most prevalent underlying disease was diabetes mellitus (45.3%). Bullae were recognized in 37.3% of patients. One third of cases were complicated by bacteremia. Polymicrobial infections were found in 30.7% of patients. Overall mortality rate for GAS necrotizing fasciitis was 16%. Patients aged >60 years with diabetes mellitus, liver cirrhosis, and gout were considerably more likely to have GAS necrotizing fasciitis than noninvasive infections. Patients presenting with bacteremia, shock, duration of symptoms/signs <5 days, low white blood cell count, low platelet count, and prolonged prothrombin time were associated with increased mortality. Surgery is a significantly negative factor for mortality of patients with GAS necrotizing fasciitis (odds ratio = 0.16; 95% confidence interval 0.002-0.16; p < 0.001).
A better understanding of the associated factors and initiation of adequate treatments will allow for improved survival after GAS necrotizing fasciitis.
A组链球菌（GAS）坏死性筋膜炎是一种严重的急症。坏死性筋膜炎患者主要前往急诊科就诊，但大多数研究聚焦于住院患者。
开展一项基于急诊科患者的回顾性研究，以调查急诊科中GAS坏死性筋膜炎的临床特征、相关因素及预后。
纳入2005年1月至2011年12月期间前往急诊科就诊且诊断为GAS坏死性筋膜炎的患者。所有诊断为GAS引起的非侵袭性皮肤和软组织感染的患者被纳入对照组。
在研究期间，共识别出75例GAS坏死性筋膜炎患者。男性占患者总数的84%。最常见的基础疾病是糖尿病（45.3%）。37.3%的患者出现大疱。三分之一的病例合并菌血症。30.7%的患者存在多微生物感染。GAS坏死性筋膜炎的总体死亡率为16%。年龄>60岁且患有糖尿病、肝硬化和痛风的患者比非侵袭性感染患者更易患GAS坏死性筋膜炎。出现菌血症、休克、症状/体征持续时间<5天、白细胞计数低、血小板计数低及凝血酶原时间延长的患者死亡率增加。手术是GAS坏死性筋膜炎患者死亡的显著负面因素（比值比=0.16；95%置信区间0.002 - 0.1；p<0.001）。
更好地了解相关因素并启动适当治疗将有助于提高GAS坏死性筋膜炎后的生存率。
