Soedjana Hardisiswo, Christine Sitha, Sisca Fransisca
Division of Plastic and Reconstructive Surgery, Department of Surgery, Rumah Sakit Umum Pusat Dr. Hasan Sadikin/Universitas Padjadjaran, Kota Bandung, Indonesia.
Int Wound J. 2024 Jan;21(1):e14355. doi: 10.1111/iwj.14355. Epub 2023 Aug 18.
Necrotizing fasciitis is a progressive and rare disease, with high potential to be life-threatening because of its potential for systemic toxicity. Characterized by fascial infection, it is often followed by systemic toxicity, such as septic shock and multi-organ failure. The aim of this study is to establish reliable data on the treatment of necrotizing fasciitis patients at the topmost referral hospital in West Java, Indonesia. We collected medical record data from January 2015 to December 2021 at Rumah Sakit Umum Pusat Dr. Hasan Sadikin (RSHS), Bandung, Indonesia. We recorded the infection region, bacterial isolates, empirical antibiotics, waiting time for the first surgery, surgical management, length of stay and we analysed the pattern of bacterial isolates, antibiotic use, waiting time for the first surgery, length of stay and mortality. A total of 90 patients' medical records were analysed. We found that the infection was most found in the genitalia and inguinal region (37%). Eighty-five percent of all samples containing gram-negative bacteria. The most used empirical antibiotics were from Cephalosporin class (31%), most of them combined with nitroimidazole (metronidazole) and with quinolones (levofloxacin, ciprofloxacin). Overall mortality rate was 13.3%. Highest mortality rate came from gram-negative bacteria group (14.2%-11 out of 77 patients), patients receiving Ceftriaxone-Metronidazole as empirical antibiotics (28.57%-4 out of 14 patients), patients with no surgery group (37%-3 out of 8 patients), with no mortality came from patients, which were performed debridement followed by fasciotomy/skin graft/flap and amputation. We conclude that the most found bacterial aetiology was Acinetobacter baumanii though it has no significant relation to mortality. We highly recommend early aggressive surgical intervention in reducing mortality rate due to necrotizing fasciitis for source control accompanied by deliberate defect closure and early administration of empirical antibiotics with more susceptibility for gram-negative bacteria, such as Meropenem.
坏死性筋膜炎是一种进展性的罕见疾病，因其具有全身毒性的可能性，所以具有很高的潜在生命威胁性。其特征为筋膜感染，常伴有全身毒性，如感染性休克和多器官功能衰竭。本研究的目的是在印度尼西亚西爪哇省顶级转诊医院建立关于坏死性筋膜炎患者治疗的可靠数据。我们收集了2015年1月至2021年12月在印度尼西亚万隆哈桑·萨迪金博士综合医院（RSHS）的病历数据。我们记录了感染部位、细菌分离株、经验性抗生素、首次手术等待时间、手术管理、住院时间，并分析了细菌分离株模式、抗生素使用情况、首次手术等待时间、住院时间和死亡率。共分析了90例患者的病历。我们发现感染最常发生在生殖器和腹股沟区域（37%）。所有样本中85%含有革兰氏阴性菌。最常用的经验性抗生素来自头孢菌素类（31%），其中大多数与硝基咪唑（甲硝唑）和喹诺酮类（左氧氟沙星、环丙沙星）联合使用。总体死亡率为13.3%。最高死亡率来自革兰氏阴性菌组（14.2%——77例患者中的11例），接受头孢曲松-甲硝唑作为经验性抗生素的患者（28.57%——14例患者中的4例），未进行手术组的患者（37%——8例患者中的3例），而接受清创术随后进行筋膜切开术/植皮/皮瓣和截肢手术的患者无死亡病例。我们得出结论，最常见的细菌病因是鲍曼不动杆菌，尽管它与死亡率没有显著关系。我们强烈建议早期积极的手术干预，以降低坏死性筋膜炎导致的死亡率，进行源头控制，同时谨慎关闭伤口，并早期使用对革兰氏阴性菌更敏感的经验性抗生素，如美罗培南。
