Rampal Sanjiv, Ganesan Thanusha, Sisubalasingam Narresh, Neela Vasantha Kumari, Tokgöz Mehmet Ali, Arunasalam Arun, Ab Halim Mohd Asyraf Hafizuddin, Shamsudin Zulfahrizzat Bin, Kumar Suresh, Sinniah Ajantha
Department of Orthopaedic and Traumatology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Malaysia.
Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
Antibiotics (Basel). 2021 Sep 17;10(9):1120. doi: 10.3390/antibiotics10091120.
Necrotizing fasciitis (NF) is a rapidly progressive inflammatory infection of the soft tissue (also known as the fascia) with a secondary necrosis of the subcutaneous tissues, leading to a systemic inflammatory response syndrome (SIRS), shock and eventually death despite the availability of current medical interventions. The clinical management of this condition is associated with a significant amount of morbidity with a high rate of mortality. The prognosis of the disease is affected by multiple factors, which include the virulence of the causative pathogen, local host immunity, local wound factors and empirical antibiotics used. The local trends in the prescription of empirical antibiotics are often based on clinical practice guidelines (CPG), the distribution of the causative microorganism and the cost-effectiveness of the drug. However, there appears to be a paucity of literature on the empirical antibiotic of choice when dealing with necrotizing fasciitis in the clinical setting. This paper will outline common causative microorganisms and current trends of prescription in two tertiary centres in Central Malaysia.
This was a cross-sectional study using retrospective data of patients treated for NF collected from two tertiary care hospitals (Hospital Seremban and Hospital Ampang) in Central Malaysia. A total of 420 NF patients were identified from the five years of retrospective data obtained from the two hospitals.
The top three empirical antibiotics prescribed are ampicillin + sulbactam ( = 258; 61.4%), clindamycin ( = 55; 13.1%) and ceftazidime ( = 41; 9.8%). The selection of the antibiotic significantly impacts the outcome of NF. The top three causative pathogens for NF are spp. ( = 79; 18.8%), ( = 61; 14.5%) and spp. ( = 49; 11.7%). The patients who received antibiotics had 0.779 times lower chances of being amputated. Patients with a lower laboratory risk indicator for necrotizing fasciitis (LRINEC) score had 0.934 times lower chances of being amputated.
In this study, the most common empirical antibiotic prescribed was ampicillin + sulbactam followed by clindamycin and ceftazidime. The antibiotics prescribed lower the risk of having an amputation and, hence, a better prognosis of the disease. Broad-spectrum empirical antibiotics following surgical debridement reduce the mortality rate of NF.
坏死性筋膜炎（NF）是一种软组织（也称为筋膜）的快速进展性炎症感染，伴有皮下组织的继发性坏死，尽管有当前的医疗干预措施，但仍会导致全身炎症反应综合征（SIRS）、休克并最终死亡。这种疾病的临床管理伴随着大量的发病率和高死亡率。该疾病的预后受多种因素影响，包括致病病原体的毒力、局部宿主免疫力、局部伤口因素以及使用的经验性抗生素。经验性抗生素处方的局部趋势通常基于临床实践指南（CPG）、致病微生物的分布以及药物的成本效益。然而，在临床环境中处理坏死性筋膜炎时，关于首选经验性抗生素的文献似乎很少。本文将概述马来西亚中部两个三级中心常见的致病微生物和当前的处方趋势。
这是一项横断面研究，使用从马来西亚中部的两家三级护理医院（芙蓉医院和安邦医院）收集的坏死性筋膜炎患者的回顾性数据。从两家医院获得的五年回顾性数据中，共识别出420例坏死性筋膜炎患者。
处方最多的三种经验性抗生素是氨苄西林+舒巴坦（=258；61.4%）、克林霉素（=55；13.1%）和头孢他啶（=41；9.8%）。抗生素的选择对坏死性筋膜炎的结局有显著影响。坏死性筋膜炎的前三种致病病原体是金黄色葡萄球菌（=79；18.8%）、化脓性链球菌（=61；14.5%）和大肠埃希菌（=49；11.7%）。接受抗生素治疗的患者截肢的可能性降低0.779倍。坏死性筋膜炎实验室风险指标（LRINEC）评分较低的患者截肢的可能性降低0.934倍。
在本研究中，处方最多的经验性抗生素是氨苄西林+舒巴坦，其次是克林霉素和头孢他啶。所开的抗生素降低了截肢的风险，因此疾病的预后更好。手术清创后使用广谱经验性抗生素可降低坏死性筋膜炎的死亡率。
