Recent Trend of Necrotizing Fasciitis in Taiwan: Focus on Monomicrobial Klebsiella pneumoniae Necrotizing Fasciitis
Recent Trend of Necrotizing Fasciitis in Taiwan: Focus on Monomicrobial Klebsiella pneumoniae Necrotizing Fasciitis
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DOI：
10.1093/cid/cis565
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发表时间：
2012-10-01
影响因子：
11.8
通讯作者：
Fang, Chi-Tai
中科院分区：
文献类型：
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作者：
Cheng, Nai-Chen;Yu, Yen-Chen;Fang, Chi-Tai
背景坏死性筋膜炎（NF）是一种快速进展，危及生命的软组织感染，传统上由A组链球菌（GAS）或混合需氧/厌氧菌引起。单菌肺炎克雷伯氏菌NF（KP-NF）自1996年以来已有报道，但尚未得到系统研究。我们回顾性研究了1997-2010年在台湾一所大学医院治疗的连续NF病例，并以单菌GAS-NF作为参考，研究了与单菌KP-NF相关的临床特征和结局。并对分离菌株的毒力基因进行了分析。结果：在134例NF中，88例为单菌性，其中最常见的病原体为GAS（n = 16）和K。肺炎（n = 15）。单抗KP-NF具有中度肢体丧失风险（20% vs 25%; P = 1.000）和高死亡率（47%对19%; P = .135），更可能涉及菌血症（80% vs 31%; P = 0.011），伴发远处转移（27%对0%; P = 0.043），和潜在的免疫妥协条件（100%对63%; P = 0.018），与GAS-NF相比。孤立的K。肺炎菌株（n = 10）为荚膜多糖基因型K1（n = 4）、K54/K20/K5（n = 4）、K2（n = 1）和K16（n = 1）。所有菌株均携带rmpA、iucABCDiu-tA和iroA。与非K1菌株相比，基因型K1菌株伴随远处脓肿的风险显着更高（75% vs 0%; P = 0.033）。结论。K.在台湾，肺炎已成为单一微生物NF的常见病原体。治疗单一抗菌药物KP-NF患者的医生应注意伴随远处转移的风险，特别是由基因型K1引起的病例。
Background. Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft-tissue infection that is traditionally caused by group A Streptococcus (GAS) or mixed aerobic/anaerobic bacteria. Monomicrobial Klebsiella pneumoniae NF (KP-NF) has been reported since 1996 but has not yet been systematically studied.Methods. We retrospectively studied consecutive NF cases treated at a university hospital in Taiwan during 1997-2010 and investigated the clinical characteristics and outcomes associated with monomicrobial KP-NF, using monomicrobial GAS-NF as a reference. We also analyzed the virulence gene profiles of the isolated K. pneumoniae strains.Results. Of 134 NF cases, 88 were monomicrobial, of which the most common pathogens were GAS (n = 16) and K. pneumoniae (n = 15). Monomicrobial KP-NF entailed a moderate risk of limb loss (20% vs 25%; P = 1.000) and high mortality (47% vs 19%; P = .135), and it was more likely to involve bacteremia (80% vs 31%; P = .011), concomitant distant abscesses (27% vs 0%; P = .043), and underlying immunocompromising conditions (100% vs 63%; P = .018), compared with GAS-NF. The isolated K. pneumoniae strains (n = 10) were of capsular polysaccharides genotype K1 (n = 4), K54/K20/K5 (n = 4), K2 (n = 1), and K16 (n = 1). All strains carried rmpA, iucABCDiu-tA, and iroA. Genotype K1 strains had a significantly higher risk of concomitant distant abscesses, compared with non-K1 strains (75% vs 0%; P = .033).Conclusions. K. pneumoniae has become a common pathogen of monomicrobial NF in Taiwan. Physicians treating patients with monomicrobial KP-NF should be aware of the risk of concomitant distant abscesses, particularly in cases caused by genotype K1.