Necrotizing fasciitis caused by mono-bacterial gram-negative infection with E. coli - the deadliest of them all: A case series and review of the literature.

Bayard, I. P. E.; Grobbelaar, A. O.; Constantinescu, M. A. (2021). Necrotizing fasciitis caused by mono-bacterial gram-negative infection with E. coli - the deadliest of them all: A case series and review of the literature. JPRAS open, 29, pp. 99-105. Elsevier 10.1016/j.jpra.2021.04.007

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Introduction

Unlike other skin and soft tissue infections, necrotizing fasciitis (NF) is a very rare but potentially fatal condition. Common organisms causing NF are poly-microbial (type I) infection with mixed organisms and mono-bacterial gram-positive infection with mainly streptococci (type II). Mono-bacterial gram-negative NF is a rare form of NF that is not included in the current classification.

Case series

We report four cases of mono-bacterial gram-negative NF caused by E. coli. All patients presented in septic shock and showed landscape-like skin necrosis and pain out of proportion. Radical debridement and escalation of antibiotic treatment was performed in all patients. Short-term survival was 50%. Two patients died of multiorgan failure. Two patients survived short term: One patient was amputated through the knee but died six months later of metastatic prostate cancer. One patient was covered with split thickness skin grafts and died three months later of catheter-associated sepsis with endocarditis.

Discussion

Recent findings suggest adding a type III fasciitis, which is caused by mono-bacterial gram-negative organisms. As patients are getting older with even more comorbidities, mono-bacterial gram-negative NF will be an increasing problem for physicians treating soft tissue and skin infections.In oncologic diseases, liver cirrhosis, renal diseases or otherwise immunocompromised patients, mono-bacterial gram-negative NF with E. coli is underestimated. Therefore, in these patients, antibiotic treatment should cover Gram-negative organisms including E. coli. However even with adjusted antibiotic treatment and radical debridement, the short-term survival and long-term outcome are poor.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery > Plastic, Reconstructive and Aesthetic Surgery
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery

UniBE Contributor:

Bayard, Ivo; Grobbelaar, Adriaan Ockert and Constantinescu, Mihai Adrian

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2352-5878

Publisher:

Elsevier

Language:

English

Submitter:

Veronika Picha

Date Deposited:

06 Jul 2021 14:38

Last Modified:

06 Jul 2021 14:43

Publisher DOI:

10.1016/j.jpra.2021.04.007

PubMed ID:

34189236

Uncontrolled Keywords:

Escherichia coli Landscape-like skin necrosis Mono-bacterial Gram-negative Necrotizing fasciitis

BORIS DOI:

10.48350/157402

URI:

https://boris.unibe.ch/id/eprint/157402

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