坏死性筋膜炎，病原体及治疗：马来西亚中部两家三级护理医院的五年回顾性研究。

Necrotizing fasciitis, causative agents and management: a five-year retrospective study in two tertiary care hospitals in Central Malaysia.

机构信息

Department of Orthopaedic, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia.

Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia.

出版信息

Int Orthop. 2021 Jun;45(6):1399-1405. doi: 10.1007/s00264-020-04905-2. Epub 2021 Jan 23.

DOI:10.1007/s00264-020-04905-2

PMID:33484294

Abstract

PURPOSE

Necrotizing fasciitis (NF) is a rapidly progressive inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues. The severity of the disease depends on the virulence of the organism and host immunity. There is a paucity of reports on the prevalence of NF causing pathogens and management.

METHODS

Retrospective data of patients treated for NF were collected from two tertiary care hospitals in Central Malaysia between January 2014 and December 2018.

RESULTS

A total of 469 NF patients were identified. More than half of the NF patients were males (n = 278; 59.28%). The highest number of cases was found among age groups between 30 and 79, with mean age of 56.17. The majority of the NF cases (n = 402; 85.72%) were monomicrobial. Streptococcus spp. (n = 89; 18.98%), Pseudomonas aeruginosa (n = 63; 13.44%) and Staphylococcus spp. (n = 61; 13.01%) were identified as the top three microorganisms isolated. Among the 469 NF cases, 173 (36.8%) were amputated or dead while 296 (63.1%) recovered. Proteus spp. (n = 19; 12.93%), Klebsiella pneumoniae (n = 18; 12.24%) and Escherichia coli (n = 14; 9.52%) were associated with all types of amputations. The most common antibiotic prescribed was unasyn (n = 284; 60.56%), followed by clindamycin (n = 56; 11.94%) and ceftazidime (n = 41; 8.74%). A total of 239 (61.8%) recovered while 148 (38.2%) were either amputated or dead when managed with the unasyn, clindamycin or ceftazidime.

CONCLUSION

This study represents the largest NF cases series in Malaysia highlighting the causative agents and management.

摘要

目的

坏死性筋膜炎（NF）是一种迅速发展的筋膜炎症感染，伴有皮下组织的继发性坏死。疾病的严重程度取决于病原体的毒力和宿主的免疫能力。目前关于导致 NF 的病原体和治疗方法的报道很少。

方法

本研究回顾性收集了 2014 年 1 月至 2018 年 12 月马来西亚中部两家三级护理医院治疗的 NF 患者的数据。

结果

共确定了 469 例 NF 患者。超过一半的 NF 患者为男性（n = 278；59.28%）。年龄在 30 至 79 岁之间的 NF 病例最多，平均年龄为 56.17 岁。大多数 NF 病例（n = 402；85.72%）为单微生物感染。链球菌属（n = 89；18.98%）、铜绿假单胞菌（n = 63；13.44%）和葡萄球菌属（n = 61；13.01%）是分离出的前三种微生物。在 469 例 NF 病例中，173 例（36.8%）截肢或死亡，296 例（63.1%）康复。变形杆菌属（n = 19；12.93%）、肺炎克雷伯菌（n = 18；12.24%）和大肠杆菌（n = 14；9.52%）与所有类型的截肢都有关。最常开的抗生素是unasyn（n = 284；60.56%），其次是克林霉素（n = 56；11.94%）和头孢他啶（n = 41；8.74%）。unasyn、克林霉素或头孢他啶治疗后，239 例（61.8%）康复，148 例（38.2%）截肢或死亡。