Abd El-Hamid El-Kady Rania, Ahmed Mansour Ahd, ElGuindy Ahmed Mahmoud Fouad
Department of Medical Microbiology and Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Pathological Sciences Department, MBBS Program, Fakeeh College for Medical Sciences, Jeddah, 21461, Kingdom of Saudi Arabia.
Int J Gen Med. 2025 Jul 19;18:3983-4000. doi: 10.2147/IJGM.S533021. eCollection 2025.
Necrotizing fasciitis (NF) is a potentially lethal soft tissue infection, with a high rate of morbidity and mortality. Data on the microbiological aspects of NF from Saudi Arabia are extremely lacking. Thereby, we endeavored in this study to highlight the microbial causes of NF and their antimicrobial resistance profiles, as well as the risk factors and independent predictors for development of multi-drug resistant (MDR) strains.
Over a period of three years, we retrospectively reviewed the medical, intraoperative, and laboratory electronic records of adult patients diagnosed with NF in our institution. We analyzed the risk factors for acquisition of MDR-NF using univariate analysis, whereas a multivariate regression model was generated to identify the independent predictors for MDR-NF.
Out of 38 adult patients diagnosed with NF, 27 (71.1%) were males and the mean age was 60.11 ±13.57 years. The lower extremities were the most common site for NF (36.8%). Overall, monomicrobial NF (58%) was more frequent than the polymicrobial type (42%). A relatively high rate of MDR organisms was identified amongst the Gram-negative isolates (33.3%). Risk factors for MDR-NF included increased hospital length of stay, intensive care unit (ICU) admission, old age, coexisting malignancy, and increased Laboratory Risk Indicator for Necrotizing Fasciitis score. The multivariate analysis identified lengthy hospital stays and ICU admission as the independent predictors for MDR infections.
Our study showed that MDR-NF is a growing challenge in clinical practice that poses negative impacts on the patient outcomes as well as health care resources. On that premise, it is crucial to enforce antimicrobial stewardship guidelines, and to improve our infection control policies to mitigate the escalating surge of MDR organisms. Furthermore, thorough active surveillance studies and enhanced collaboration amongst healthcare professionals are pivotal for early recognition and intervention.
坏死性筋膜炎（NF）是一种具有潜在致命性的软组织感染，发病率和死亡率很高。沙特阿拉伯关于NF微生物学方面的数据极其匮乏。因此，我们在本研究中致力于突出NF的微生物病因及其抗菌药物耐药谱，以及多重耐药（MDR）菌株产生的危险因素和独立预测因素。
在三年时间里，我们回顾性分析了我院诊断为NF的成年患者的医疗、术中及实验室电子记录。我们使用单因素分析来分析获得MDR-NF的危险因素，同时建立多因素回归模型以确定MDR-NF的独立预测因素。
在38例诊断为NF的成年患者中，27例（71.1%）为男性，平均年龄为60.11±13.57岁。下肢是NF最常见的部位（36.8%）。总体而言，单微生物性NF（58%）比多微生物性NF（42%）更常见。在革兰阴性菌分离株中发现相对较高比例的MDR菌（33.3%）。MDR-NF的危险因素包括住院时间延长、入住重症监护病房（ICU）、老年、并存恶性肿瘤以及坏死性筋膜炎实验室风险指标评分增加。多因素分析确定住院时间长和入住ICU是MDR感染的独立预测因素。
我们的研究表明，MDR-NF在临床实践中是一个日益严峻的挑战，对患者预后和医疗资源都有负面影响。在此前提下，执行抗菌药物管理指南以及改进我们的感染控制政策以减轻MDR菌不断上升的流行趋势至关重要。此外，全面的主动监测研究以及医疗专业人员之间加强合作对于早期识别和干预至关重要。
