Bacterial Isolates from Necrotizing Fasciitis : a Clinico-Pathological Perspective

ABSTRACT

Background: Necrotizing fasciitis (NF) is a progressive; polymicrobial; potentially fatal soft tissue infection that can affect both sexes; all age groups and any anatomical region of the body. Identification of the offending microorganisms is important; since the eventual outcomeof treatment is dependent on aggressive; chemotherapeutic and supportive therapy. Aim: To determine the spectrum of aerobic bacterialorganisms responsible for NF in Sokoto; Northwestern Nigeria; and to establish a baseline for which further studies can be conduct Patients and Methods: A 5-year prospective study of aerobic bacteria isolated from all consecutive patients with NF seen at the Usmanu Danfodiyo University Teaching Hospital; Sokoto; Nigeria from January 2001 to December 2005. All necessary information from each patient was fed into the computer for analysis. Results: There were 62 patients; of which 33 (53.2) were males while the remaining 29 (46.8) were females. The ages ranged from six days to 70 years (mean = 21.4 years). One or more precipitating factors were identified in) patients; while 40 (64.5) patients had identifiable pre-morbid pathology. The body surface area (BSA) involved ranged from 1 3 32 (51.6). The commonest anatomical region involved was the trunk in 23 (37.1) patients; this was followed by the lower limbs; upper limbs; head and neck; perineum and buttocks in that order. From the 62 patients; 176 aerobic cultures were carried out. Of this; 147 cultures (83.5) were positive; while the remaining 29 (16.5) grew no organisms after 48 hours of incubation. The commonest offending organisms were Staphylococcus aureus and Pseudomonas aeruginosa. Infection was polymicrobial in; 64 of patients. Cephalosporins; quinolones and aminoglycosides were the most sensitive antibiotics. Multiple wound debridements were required in nearly half of the patients. The duration of hospital stay ranged from 3 132 days (mean = 39 days). The overall mortality was 14.5. Conclusion: NF is essentially polymicrobial; deriving significant contributions from both gram-negative and gram-positive bacteria. The cultural characteristics of the disease; and sensitivity to antibiotics; require periodic assessments