The Impact of Cefuroxime Susceptibility on Aeromonas Necrotizing Fasciitis Outcomes
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Definitions
2.3. Laboratory Procedures for Microbiology
2.4. Antimicrobial Susceptibility Testing
2.5. Disk-Diffusion Method
2.6. E-Test
2.7. Statistical Analysis
3. Results
3.1. Patient Selection and Clinical Isolates
3.2. Microbiological Analysis and Empiric Antibiotics
3.3. Data on Demographics, Characteristics, and Clinical Outcomes
3.4. Surgical Treatment
3.5. Clinical Presentations
3.6. Laboratory Findings
4. Discussion
5. Conclusions
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
- Janda, J.M.; Abbott, S.L. The genus Aeromonas: Taxonomy, pathogenicity, and infection. Clin. Microbiol. Rev. 2010, 23, 35–73. [Google Scholar] [CrossRef] [PubMed]
- Parker, J.L.; Shaw, J.G. Aeromonas spp. clinical microbiology and disease. J. Infect. 2011, 62, 109–118. [Google Scholar] [CrossRef] [PubMed]
- Tsai, Y.H.; Huang, K.C.; Huang, T.J.; Hsu, R.W. Case reports: Fatal necrotizing fasciitis caused by Aeromonas sobria in two diabetic patients. Clin. Orthop. Relat. Res. 2009, 467, 846–849. [Google Scholar] [CrossRef] [PubMed]
- Tsai, Y.H.; Shen, S.H.; Yang, T.Y.; Chen, P.H.; Huang, K.C.; Lee, M.S. Monomicrobial necrotizing fasciitis caused by aeromonas hydrophila and Klebsiella pneumoniae. Med. Princ. Pract. 2015, 24, 416–423. [Google Scholar] [CrossRef] [PubMed]
- Huang, T.Y.; Peng, K.T.; Hsu, W.H.; Hung, C.H.; Chuang, F.Y.; Tsai, Y.H. Independent predictors of mortality for aeromonas necrotizing fasciitis of Limbs: An 18-year retrospective study. Sci. Rep. 2020, 10, 7716. [Google Scholar] [CrossRef] [PubMed]
- Huang, T.Y.; Tsai, Y.H.; Lee, C.Y.; Hsu, W.H.; Hsiao, C.T.; Huang, Y.K.; Li, Y.Y.; Chen, J.L.; Kuo, S.F.; Hsiao, J.C.; et al. Rational use of antibiotics and education improved aeromonas necrotizing fasciitis outcomes in Taiwan: A 19-year experience. Antibiotics 2022, 11, 1782. [Google Scholar] [CrossRef]
- Tsai, Y.H.; Hsu, R.W.; Huang, T.J.; Hsu, W.H.; Huang, K.C.; Li, Y.Y.; Peng, K.T. Necrotizing soft-tissue infections and sepsis caused by Vibrio vulnificus compared with those caused by Aeromonas species. J. Bone Jt. Surg. Am. 2007, 89, 631–636. [Google Scholar] [CrossRef]
- Tsai, Y.H.; Huang, T.Y.; Chen, J.L.; Hsiao, C.T.; Kuo, L.T.; Huang, K.C. Bacteriology and mortality of necrotizing fasciitis in a tertiary coastal hospital with comparing risk indicators of methicillin-resistant Staphylococcus aureus and Vibrio vulnificus infections: A prospective study. BMC Infect. Dis. 2021, 21, 771. [Google Scholar] [CrossRef]
- Tsai, Y.H.; Hsu, R.W.; Huang, K.C.; Chen, C.H.; Cheng, C.C.; Peng, K.T.; Huang, T.J. Systemic Vibrio infection presenting as necrotizing fasciitis and sepsis. A series of thirteen cases. J. Bone Jt. Surg. Am. 2004, 86, 2497–2502. [Google Scholar] [CrossRef]
- Chen, W.D.; Lai, L.J.; Hsu, W.H.; Huang, T.Y. Vibrio cholerae non-O1—The first reported case of keratitis in a healthy patient. BMC Infect. Dis. 2019, 19, 916. [Google Scholar] [CrossRef]
- Huang, T.Y.; Peng, K.T.; Hsiao, C.T.; Fann, W.C.; Tsai, Y.H.; Li, Y.Y.; Hung, C.H.; Chuang, F.Y.; Hsu, W.H. Predictors for gram-negative monomicrobial necrotizing fasciitis in southern Taiwan. BMC Infect. Dis. 2020, 20, 60. [Google Scholar] [CrossRef] [PubMed]
- Huang, T.Y.; Tsai, Y.H.; Kuo, L.T.; Hsu, W.H.; Hsiao, C.T.; Hung, C.H.; Huang, W.Y.; Wu, H.R.; Chuang, H.J.; Li, Y.Y.; et al. Different types of bullae of limbs with necrotizing fasciitis predict different outcome: A prospective study. Infection 2021, 49, 135–144. [Google Scholar] [CrossRef] [PubMed]
- Wong, C.H.; Chang, H.C.; Pasupathy, S.; Khin, L.W.; Tan, J.L.; Low, C.O. Necrotizing fasciitis: Clinical presentation, microbiology, and determinants of mortality. J. Bone Jt. Surg. Am. 2003, 85, 1454–1460. [Google Scholar] [CrossRef]
- Kunin, C.M.; Tupasi, T.; Craig, W.A. Use of antibiotics. A brief exposition of the problem and some tentative solutions. Ann. Intern. Med. 1973, 79, 555–560. [Google Scholar] [CrossRef] [PubMed]
- M45-A2; Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria. Approved Guideline. 2nd ed. Clinical and Laboratory Standards Institute: Wayne, PA, USA, 2010.
- Janda, J.M.; Abbott, S.L. Evolving concepts regarding the genus Aeromonas: An expanding Panorama of species, disease presentations, and unanswered questions. Clin. Infect. Dis. 1998, 27, 332–344. [Google Scholar] [CrossRef] [PubMed]
- Ko, W.C.; Chuang, Y.C. Aeromonas bacteremia: Review of 59 episodes. Clin. Infect. Dis. 1995, 20, 1298–1304. [Google Scholar] [CrossRef]
- Ko, W.C.; Lee, H.C.; Chuang, Y.C.; Liu, C.C.; Wu, J.J. Clinical features and therapeutic implications of 104 episodes of monomicrobial Aeromonas bacteraemia. J. Infect. 2000, 40, 267–273. [Google Scholar] [CrossRef]
- Gold, W.L.; Salit, I.E. Aeromonas hydrophila infections of skin and soft tissue: Report of 11 cases and review. Clin. Infect. Dis. 1993, 16, 69–74. [Google Scholar] [CrossRef]
- Holmberg, S.D.; Schell, W.L.; Fanning, G.R.; Wachsmuth, I.K.; Hickman-Brenner, F.W.; Blake, P.A.; Brenner, D.J.; Farmer, J.J. 3rd: Aeromonas intestinal infections in the United States. Ann. Intern. Med. 1986, 105, 683–689. [Google Scholar] [CrossRef]
- Xu, C.; Lin, Q.; Zhao, Y.; Zhu, G.; Jiang, E.; Li, S.; Mi, Y.; Zheng, Y.; Zhang, F.; Zhu, X.; et al. Clinical characteristics and risk factors of Aeromonas bloodstream infections in patients with hematological diseases. BMC Infect. Dis. 2022, 22, 303. [Google Scholar] [CrossRef]
- Lau, S.M.; Peng, M.Y.; Chang, F.Y. Outcomes of Aeromonas bacteremia in patients with different types of underlying disease. J. Microbiol. Immunol. Infect. 2000, 33, 241–247. [Google Scholar] [PubMed]
- Green, R.J.; Dafoe, D.C.; Raffin, T.A. Necrotizing fasciitis. Chest 1996, 110, 219–229. [Google Scholar] [CrossRef] [PubMed]
- Di, W.; Cui, J.; Yu, H.; Cui, X.; Sa, H.; Fu, Z.; Fu, B.; Guan, G.; Du, R.; Shao, C.; et al. Vibrio vulnificus necrotizing fasciitis with sepsis presenting with pain in the lower legs in winter: A case report. BMC Infect. Dis. 2022, 22, 670. [Google Scholar] [CrossRef]
- Chan, Y.Y.; Lin, T.Y.; Huang, C.T.; Deng, S.T.; Wu, T.L.; Leu, H.S.; Chiu, C.H. Implementation and outcomes of a hospital-wide computerised antimicrobial stewardship programme in a large medical centre in Taiwan. Int. J. Antimicrob. Agents 2011, 38, 486–492. [Google Scholar] [CrossRef] [PubMed]
- Huang, T.Y.; Hung, C.H.; Lai, L.J.; Chuang, H.J.; Wang, C.C.; Lin, P.T.; Hsu, W.H. Implementation and outcomes of hospital-wide computerized antimicrobial approval system and on-the-spot education in a traumatic intensive care unit in Taiwan. J. Microbiol. Immunol. Infect. 2018, 51, 672–680. [Google Scholar] [CrossRef] [PubMed]
- Heatley, N.G. A method for the assay of penicillin. Biochem. J. 1944, 38, 61–65. [Google Scholar] [CrossRef]
- Wiegand, I.; Hilpert, K.; Hancock, R.E. Agar and broth dilution methods to determine the minimal inhibitory concentration (MIC) of antimicrobial substances. Nat. Protoc. 2008, 3, 163–175. [Google Scholar] [CrossRef]
- Brown, D.F.; Brown, L. Evaluation of the E test, a novel method of quantifying antimicrobial activity. J. Antimicrob. Chemother. 1991, 27, 185–190. [Google Scholar] [CrossRef]
- Baquero, F.; Cantón, R.; Martinez-Beltrán, J.; Bolmström, A. The E-test as an epidemiologic tool. Diagn. Microbiol. Infect. Dis. 1992, 15, 483–487. [Google Scholar] [CrossRef]
- Andrews, J.M. Determination of minimum inhibitory concentrations. J. Antimicrob. Chemother. 2001, 48 (Suppl. S1), 5–16. [Google Scholar] [CrossRef]
- Lamy, B.; Laurent, F.; Kodjo, A.; Roger, F.; Jumas-Bilak, E.; Marchandin, H. Which antibiotics and breakpoints should be used for Aeromonas susceptibility testing? Considerations from a comparison of agar dilution and disk diffusion methods using Enterobacteriaceae breakpoints. Eur. J. Clin. Microbiol. Infect. Dis. 2012, 31, 2369–2377. [Google Scholar] [CrossRef] [PubMed]
- Wheat, P.F. History and development of antimicrobial susceptibility testing methodology. J. Antimicrob. Chemother. 2001, 48 (Suppl. S1), 1–4. [Google Scholar] [CrossRef] [PubMed]
- Vila, J.; Marco, F.; Soler, L.; Chacon, M.; Figueras, M.J. In vitro antimicrobial susceptibility of clinical isolates of Aeromonas caviae, Aeromonas hydrophila and Aeromonas veronii biotype sobria. J. Antimicrob. Chemother. 2002, 49, 701–702. [Google Scholar] [CrossRef] [PubMed]
- Ko, W.C.; Yu, K.W.; Liu, C.Y.; Huang, C.T.; Leu, H.S.; Chuang, Y.C. Increasing antibiotic resistance in clinical isolates of Aeromonas strains in Taiwan. Antimicrob. Agents Chemother. 1996, 40, 1260–1262. [Google Scholar] [CrossRef] [PubMed]
- Liu, C.Y.; Huang, Y.T.; Liao, C.H.; Hsueh, P.R. In vitro activities of tigecycline against clinical isolates of Aeromonas, Vibrio, and Salmonella species in Taiwan. Antimicrob. Agents Chemother. 2008, 52, 2677–2679. [Google Scholar] [CrossRef] [PubMed]
- García-Rodríguez, J.F.; Mariño-Callejo, A. The factors associated with the trend in incidence of bacteraemia and associated mortality over 30 years. BMC Infect. Dis. 2023, 23, 69. [Google Scholar] [CrossRef]
- Chen, I.C.; Li, W.C.; Hong, Y.C.; Shie, S.S.; Fann, W.C.; Hsiao, C.T. The microbiological profile and presence of bloodstream infection influence mortality rates in necrotizing fasciitis. Crit. Care 2011, 15, R152. [Google Scholar] [CrossRef]
- Lee, C.Y.; Kuo, L.T.; Peng, K.T.; Hsu, W.H.; Huang, T.W.; Chou, Y.C. Prognostic factors and monomicrobial necrotizing fasciitis: Gram-positive versus gram-negative pathogens. BMC Infect. Dis. 2011, 11, 5. [Google Scholar] [CrossRef]
- Ebmeyer, S.; Kristiansson, E.; Larsson, D.G.J. CMY-1/MOX-family AmpC β-lactamases MOX-1, MOX-2 and MOX-9 were mobilized independently from three Aeromonas species. J. Antimicrob. Chemother. 2019, 74, 1202–1206. [Google Scholar] [CrossRef]
- Chen, Y.W.; Su, S.L.; Li, C.W.; Tsai, C.S.; Lo, C.L.; Syue, L.S.; Li, M.C.; Lee, C.C.; Lee, N.Y.; Ko, W.C.; et al. Pancreaticobiliary Cancers and Aeromonas Isolates Carrying Type Ⅲ Secretion System Genes ascF-ascG Are Associated with Increased Mortality: An Analysis of 164 Aeromonas Infection Episodes in Southern Taiwan. Front. Cell. Infect. Microbiol. 2021, 11, 749269. [Google Scholar] [CrossRef]
- Gray, H.K.; Bisht, A.; Caldera, J.R.; Fossas Braegger, N.M.; Cambou, M.C.; Sakona, A.N.; Beaird, O.E.; Uslan, D.Z.; Walton, S.C.; Yang, S. Nosocomial infections by diverse carbapenemase-producing Aeromonas hydrophila associated with combination of plumbing issues and heat waves. Am. J. Infect. Control 2023. [Google Scholar] [CrossRef] [PubMed]
Case No. | AMP | SAM | CXM | CRO | CAZ | FEP | GM | AN | ETP | IMP | MEM | CIP | LVX | TC | TGC |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 128 | 16 | 1 | 1 | 0.064 | 0.032 | 0.19 | 0.75 | 4 | 4 | 0.032 | 0.004 | 0.012 | 0.75 | 0.032 |
2 | 256 | 16 | 0.75 | 0.5 | 0.096 | 0.047 | 0.25 | 2 | 4 | 4 | 0.032 | 0.008 | 0.016 | 1.5 | 1 |
3 | 2 | 2 | 3 | 0.023 | 0.19 | 1 | 0.125 | 1.5 | 0.008 | 0.5 | 0.047 | 0.094 | 0.25 | 0.5 | 0.064 |
4 | 256 | 32 | 1 | 0.5 | 0.064 | 0.047 | 0.19 | 2 | 0.125 | 0.38 | 0.094 | 4 | 0.38 | 24 | 0.38 |
5 | 256 | 64 | 1 | 1 | 0.125 | 0.094 | 0.19 | 1.5 | 8 | 0.38 | 0.032 | 0.006 | 0.016 | 1 | 0.5 |
6 | 256 | 24 | 1.5 | 1 | 0.19 | 0.064 | 0.25 | 1.5 | 0.38 | 0.38 | 0.094 | 0.006 | 0.016 | 1 | 0.38 |
7 | 1 | 1 | 2 | 0.016 | 0.19 | 0.5 | 1 | 4 | 0.002 | 0.5 | 0.012 | 0.016 | 0.032 | 1 | 0.032 |
8 | 1.5 | 2 | 2 | 0.023 | 0.19 | 1 | 0.25 | 1.5 | 4 | 0.5 | 0.047 | 0.125 | 0.19 | 0.5 | 0.064 |
9 | 2 | 1.5 | 32 | 4 | 0.125 | 1 | 0.125 | 1.5 | 0.008 | 0.75 | 0.032 | 0.125 | 0.25 | 0.5 | 0.047 |
10 | 256 | 24 | 1.5 | 0.023 | 0.19 | 0.094 | 0.25 | 1.5 | 0.008 | 0.5 | 0.047 | 0.125 | 0.032 | 0.5 | 0.047 |
11 | 256 | 2 | 32 | 4 | 16 | 0.5 | 0.38 | 1.5 | 0.38 | 0.5 | 0.047 | 0.006 | 0.19 | 0.5 | 0.38 |
12 | 2 | 2 | 1 | 1 | 0.125 | 0.5 | 0.125 | 1.5 | 0.008 | 0.75 | 0.032 | 0.125 | 0.25 | 0.5 | 0.047 |
13 | 2 | 2 | 3 | 0.023 | 0.19 | 1 | 0.125 | 1.5 | 0.38 | 0.75 | 0.047 | 0.006 | 0.25 | 0.5 | 0.38 |
14 | 2 | 1.5 | 16 | 0.032 | 0.125 | 1 | 0.125 | 1.5 | 0.008 | 0.5 | 0.032 | 0.125 | 0.25 | 0.5 | 0.047 |
15 | 2 | 2 | 3 | 0.023 | 0.19 | 1 | 0.38 | 1.5 | 0.008 | 0.75 | 0.047 | 0.125 | 0.25 | 0.5 | 0.047 |
16 | 256 | 64 | 32 | 4 | 16 | 1 | 8 | 1.5 | 0.008 | 0.75 | 0.047 | 0.125 | 0.25 | 16 | 0.047 |
Antimicrobial Agents | MIC Breakpoint (μg/mL) | MIC (ug/mL) | E-Test (%) | Zone Diameter Breakpoint (mm) | Disk Diffusion (%) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
S | I | R | MIC50 b | MIC90 c | S | I | R | S | I | R | S | I | R | |
Ampicillin | ≤8 | 16 | ≥32 | 128 | 256 | 50 | 50 | ≥17 | 14–16 | ≤13 | ||||
Unasyn d | ≤8/4 | 2 | ≥32/16 | 2 | 32 | 56.3 | 25 | 18.8 | ≥15 | 12–14 | ≤11 | |||
Cefuroxime | ≤1 | 2 | ≥4 | 2 | 32 | 68.8 | 6.3 | 25 | ≥26 | 23–25 | ≤22 | 75 | 12.5 | 12.5 |
Ceftriaxone | ≤1 | 2 | ≥4 | 0.032 | 4 | 81.3 | 18.8 | ≥23 | 20–22 | ≤19 | 81.3 | 18.8 | ||
Ceftazidime | ≤4 | 8 | ≥16 | 0.125 | 0.19 | 87.5 | 12.5 | ≥21 | 18–20 | ≤17 | 87.5 | 12.5 | ||
Cefepime | ≤8 | 16 | ≥32 | 0.5 | 1 | 100 | ≥18 | 15–17 | ≤14 | |||||
Gentamicin | ≤4 | 8 | ≥16 | 0.19 | 1 | 93.8 | 6.3 | ≥15 | 13–14 | ≤12 | 93.8 | 6.3 | ||
Amikacin | ≤16 | 32 | ≥64 | 0.75 | 2 | 100 | ≥17 | 15–16 | ≤14 | 100 | ||||
Ertapenem | ≤2 | 4 | ≥8 | 0.125 | 4 | 75 | 12.5 | 12.5 | ≥19 | 16–18 | ≤15 | 68.8 | 18.8 | 12.5 |
Imipenem | ≤4 | 8 | ≥16 | 0.5 | 0.75 | 87.5 | 12.5 | ≥16 | 14–15 | ≤13 | ||||
Meropenem | ≤4 | 8 | ≥16 | 0.032 | 0.047 | 100 | ≥16 | 14–15 | ≤13 | |||||
Ciprofloxacin | ≤1 | 2 | ≥4 | 0.016 | 0.125 | 93.8 | 6.3 | ≥21 | 16–20 | ≤15 | 93.8 | 6.3 | ||
Levofloxacin | ≤2 | 4 | ≥8 | 0.19 | 0.25 | 100 | ≥17 | 14–16 | ≤13 | 100 | ||||
Tetracycline | ≤4 | 8 | ≥16 | 0.5 | 16 | 87.5 | 12.5 | ≥15 | 12–14 | ≤11 | 87.5 | 12.5 | ||
Tigecycline | ≤2 | 4 | ≥8 | 0.047 | 0.5 | 100 | ||||||||
TMP-SMX e | ≤2/38 | - | ≥4/76 | ≥16 | 11–15 | ≤10 | 81.3 | 18.8 |
Case No. | Age/ Gender | Underlying Disease | Antibiotic Regimen at ER a | First Types of Surgery | Outcome |
---|---|---|---|---|---|
1 | 63/M | Hepatitis B | Ceftriaxone, vancomycin | Fasciectomy | Recovered |
2 | 64/M | CKD b under H/D c, DM d, hepatitis C | Ceftriaxone | Debridement | Recovered |
3 | 57/M | Alcoholism, DM, hepatitis C | Ceftriaxone, doxycycline | Fasciectomy | Recovered |
4 | 76/M | DM, lymphoma, prostate cancer | Ceftriaxone, vancomycin | Fasciectomy | Recovered |
5 | 46/M | Alcoholism, DM, liver cirrhosis | Ceftriaxone, vancomycin, metronidazole | Fasciectomy | Recovered |
6 | 77/M | Not evident | Ceftriaxone, teicoplanin, metronidazole | Fasciectomy | Recovered |
7 | 49/M | Alcoholism, CKD | Ceftriaxone, teicoplanin, doxycycline | Fasciectomy | Recovered |
8 | 63/M | Alcoholism, DM | Cefazolin, doxycycline | Fasciectomy | Recovered |
9 | 52/M | Alcoholism, CKD, DM, hepatitis B, liver cirrhosis | Ceftriaxone, doxycycline | Fasciectomy | Died |
10 | 58/M | Not evident | Ceftriaxone, doxycycline | Fasciectomy | Recovered |
11 | 65/F | DM, hepatitis C | Ceftriaxone, metronidazole, doxycycline | Fasciectomy | Recovered |
12 | 54/M | Alcoholism, CKD under H/D, DM, hepatoma, liver cirrhosis | Ceftriaxone, metronidazole, doxycycline | Fasciectomy | Died, amputation |
13 | 47/M | Alcoholism, CKD under H/D, DM, hepatitis B, hepatoma, liver cirrhosis | Ceftriaxone, teicoplanin, doxycycline | Fasciectomy | Died |
14 | 79/M | Colon cancer, CKD, DM, hepatitis B & C, liver cirrhosis | Ceftriaxone, doxycycline | Fasciectomy | Recovered |
15 | 79/M | Alcoholism, CKD, hepatitis C, liver cirrhosis | Ceftriaxone, amikacin, doxycycline | Fasciectomy | Recovered |
16 | 59/M | Alcoholism, CKD under H/D, liver cirrhosis | Ceftriaxone | Debridement | Died |
Variable | Non-Survival (n = 4) | Survival (n = 12) | p-Value |
---|---|---|---|
Bloodstream infection | 4 (100) | 5 (41.7) | 0.042 * |
Monomicrobial infection | 4 (100) | 4 (33.3) | 0.021 * |
Susceptibility (MIC interpretation) | |||
Ampicillin | 3 (75) | 5 (41.7) | 0.248 |
Ampicillin-sulbactam | 3 (75) | 6 (50) | 0.411 |
Cefuroxime | 1 (25) | 10 (83.3) | 0.028 * |
Ceftriaxone | 2 (50) | 11 (91.6) | 0.064 |
Ceftazidime | 3 (75) | 11 (91.6) | 0.383 |
Cefepime | 4 (100) | 12 (100) | - |
Gentamicin | 3 (75) | 12 (100) | 0.074 |
Amikacin | 4 (100) | 12 (100) | - |
Ertapenem | 4 (100) | 8 (66.7) | 0.411 |
Imipenem | 4 (100) | 10 (83.3) | 0.383 |
Meropenem | 4 (100) | 12 (100) | - |
Ciprofloxacin | 4 (100) | 11 (91.6) | 0.551 |
Levofloxacin | 4 (100) | 12 (100) | - |
Tetracycline | 3 (75) | 11 (91.6) | 0.383 |
Tigecycline | 4 (100) | 12 (100) | - |
Colistin | 0 (0) | 5 (41.7) | 0.126 |
Ineffective empirical antimicrobial usage at ER | 3 (75) | 2 (16.7) | 0.029 * |
Variable | Non-Survival (n = 4) | Survival (n = 12) | p-Value |
---|---|---|---|
Age (years) | 53.0 ± 5.0 | 64.7 ± 11.3 | 0.069 |
Sex, male | 4 (100) | 11 (91.6) | 0.551 |
Involved region | 0.182 | ||
Lower extremities | 4 (100) | 8 (66.7) | |
Disease severity | |||
APACHE a II score | 20.0 ± 5.4 | 14.3 ± 5.9 | 0.109 |
ICU b stay | 4 (100) | 5 (41.7) | 0.042 * |
Postoperative intubation | 4 (100) | 3 (25) | 0.009 * |
Underlying chronic diseases | |||
Chronic liver dysfunction | 4 (100) | 9 (75) | 0.267 |
Alcoholism | 4 (100) | 5 (41.7) | 0.042 * |
Viral hepatitis | 2 (50) | 6 (50) | 1.000 |
Liver cirrhosis | 4 (100) | 3 (25) | 0.009 * |
Chronic kidney disease | 4 (100) | 4 (33.3) | 0.021 * |
Cancer | 2 (50) | 2 (16.7) | 0.182 |
Diabetes mellitus | 3 (75) | 7 (58.3) | 0.551 |
Misdiagnosis at ER | 1 (25) | 2 (16.7) | 0.712 |
Methods of the first operation | 0.383 | ||
Fasciectomy | 3 (75) | 11 (91.6) | |
Debridement | 1 (25) | 1 (8.3) | |
Number of surgical operations | 2.5 ± 1.7 | 2.8 ± 1.4 | 0.769 |
Clinical outcomes | |||
Number of amputations | 1 (25) | 0 (0) | 0.074 |
ICU stay (days) | 18.3 ± 15.0 | 1.1 ± 1.8 | 0.001 * |
Hospital stays (days) | 19.0 ± 17.3 | 35.9 ± 15.4 | 0.086 |
Variable | Non-Survival (n = 4) | Survival (n = 12) | p-Value |
---|---|---|---|
Duration of symptoms/signs (days) | 1.5 ± 1.0 | 1.5 ± 0.8 | 1.000 |
Symptoms/signs of systemic disease | |||
Shock a | 4 (100) | 4 (33.3) | 0.021 * |
Tachycardia b | 4 (100) | 9 (75.0) | 0.276 |
Tachypnea c | 2 (50) | 5 (41.7) | 0.771 |
Fever d | 1 (25) | 3 (25) | 1.000 |
Symptoms/signs of the limbs | |||
Pain and tenderness | 4 (100) | 11 (91.6) | 0.551 |
Swelling and erythema | 4 (100) | 9 (75.0) | 0.267 |
Hemorrhagic bullae | 2 (50) | 4 (33.3) | 0.551 |
Serous bullae | 2 (50) | 0 (0) | 0.009 * |
Skin necrosis | 2 (50) | 1 (8.3) | 0.064 |
Variable | Non-Survival (n = 4) | Survival (n = 12) | p-Value |
---|---|---|---|
Total WBC a count | |||
Leukocytosis (≥12,000/μL) | 1 (25) | 9 (75) | 0.074 |
Leukopenia (≤4000/μL) | 1 (25) | 1 (8.3) | 0.383 |
Differential count | |||
Neutrophilia (>7500/μL) | 2 (50) | 9 (75) | 0.350 |
Band forms (>10%) | 2 (50) | 4 (33.3) | 0.551 |
Lymphocytopenia (<1000/μL) | 4 (100) | 7 (58.3) | 0.119 |
Hemoglobin < 10 g/dL | 3 (75) | 1 (8.3) | 0.008 * |
Thrombocytopenia (platelet count < 15 × 104/μL) | 4 (100) | 6 (50) | 0.074 |
eGFR b < 30 c.c./min | 3 (75) | 3 (25) | 0.074 |
C-reactive protein (mg/dL) | 93.8 ± 69.5 | 108.2 ± 124.1 | 0.831 |
Albumin (mg/dL) | 2.2 ± 0.8 | 3.2 ± 0.9 | 0.054 |
PT c (s) | 25.2 ± 9.4 | 11.9 ± 2.0 | <0.001 * |
APTT d (s) | 62.7 ± 23.7 | 32.2 ± 8.2 | 0.002 * |
Total bilirubin (mg/dL) | 6.0 ± 2.6 | 1.8 ± 1.7 | 0.005 * |
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Huang, T.-Y.; Kuo, S.-F.; Tsai, Y.-H.; Chen, J.-L.; Peng, K.-T.; Huang, Y.-K.; Hung, C.-H.; Li, Y.-Y.; Li, H.-J.; Hsiao, C.-T.; et al. The Impact of Cefuroxime Susceptibility on Aeromonas Necrotizing Fasciitis Outcomes. Microorganisms 2023, 11, 2776. https://doi.org/10.3390/microorganisms11112776
Huang T-Y, Kuo S-F, Tsai Y-H, Chen J-L, Peng K-T, Huang Y-K, Hung C-H, Li Y-Y, Li H-J, Hsiao C-T, et al. The Impact of Cefuroxime Susceptibility on Aeromonas Necrotizing Fasciitis Outcomes. Microorganisms. 2023; 11(11):2776. https://doi.org/10.3390/microorganisms11112776
Chicago/Turabian StyleHuang, Tsung-Yu, Shu-Fang Kuo, Yao-Hung Tsai, Jiun-Liang Chen, Kuo-Ti Peng, Yao-Kuang Huang, Chien-Hui Hung, Yen-Yao Li, Hsing-Jung Li, Cheng-Ting Hsiao, and et al. 2023. "The Impact of Cefuroxime Susceptibility on Aeromonas Necrotizing Fasciitis Outcomes" Microorganisms 11, no. 11: 2776. https://doi.org/10.3390/microorganisms11112776