Assessing the impact of bacteremia and antibiotic resistance on mortality in patients with monomicrobial and polymicrobial Escherichia coli necrotizing fasciitis
Abstract
Background: Monomicrobial necrotizing fasciitis (NF) caused by Escherichia coli (E. coli), is exceptionally uncommon and has been reported to be associated with death. The purposes of this study were to elucidate the specific characteristics of E. coli NF, to compare the independent predictors related to surgical outcomes between the monomicrobial and polymicrobial groups, and to investigate antibiotics usage and resistance.
Methods: Twenty-five NF patients who revealed monomicrobial E. coli infection and polymicrobial NF with only E. coli growing heavy and predominant in wound and blood cultures were retrospectively reviewed over a 16-year period. Differences in in-hospital mortality, clinical outcomes, laboratory findings, presentation of bacteremia, antibiotics resistance and presentation of hemorrhagic bullae were compared between the monomicrobial and polymicrobial NF groups.
Results: Four of 10 patients (40%) with monomicrobial infections and one of 15 patients (6.7%) with polymicrobial infections died. The patients in the monomicrobial group had a significantly higher incidence of bacteremia, shock, lower total white blood cell (WBC) counts, higher banded forms, higher lactate, higher creatinine and lower platelet counts than those in the polymicrobial group. No significant difference was observed for escalation of antibiotics among the death and the survival patients while ineffective empirical antimicrobial using at initial admission.
Conclusion: Monomicrobial NF…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 15 participants or records.
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