ro13-9904 and Fasciitis--Necrotizing

Topics: Ceftriaxone; Debridement; Fasciitis, Necrotizing; Fasciotomy; Fosfomycin; Humans; Immunocompromised Host; Male; Middle Aged; Penicillin Resistance; Pneumococcal Infections; Salvage Therapy; Streptococcus pneumoniae; Treatment Outcome

Chronic kidney disease, including end-stage renal disease, has been identified as a possible risk factor for primary septicemia and wound infection by Vibrio vulnificus. However, cases of severe septicemia, necrotizing fasciitis, and peritonitis caused by V. vulnificus in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) have not been described. We report a case of severe septicemia, necrotizing fasciitis, and peritonitis due to V. vulnificus in a patient undergoing CAPD after ingesting raw seafood.. A 37-year-old woman undergoing CAPD was admitted to the emergency room due to general weakness, fever, diarrhea, and abdominal pain. Although empirical intraperitoneal antibiotics were administered for the diagnosis of CAPD-related peritonitis, her fever did not subside. On hospital day 3, she had hemorrhagic bullae on both lower legs. We evaluated her recent food history, and found that she ate raw seafood before admission. She underwent emergency fasciotomy on the suspicion of necrotizing fasciitis by V. vulnificus infection. Finally, V. vulnificus was confirmed by 16S ribosomal ribonucleic acid gene sequencing using blood and peritoneal effluent fluid cultures. The administration of intraperitoneal ceftazidime and intravenous ciprofloxacin/ceftriaxone was continued for 4 weeks, and the patient completely recovered.. Suspicion of V. vulnificus infection in vulnerable patients who ingest raw seafood is essential for prompt diagnosis, which could significantly improve patient outcomes.

Topics: Adult; Anti-Bacterial Agents; Ceftazidime; Ceftriaxone; Fasciitis, Necrotizing; Female; Humans; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; RNA, Ribosomal, 16S; Sepsis; Vibrio Infections; Vibrio vulnificus

Necrotizing fasciitis is a true surgical emergency. This study was undertaken to determine whether clinical indicators could be used to initiate early surgery, and to compare the characteristics observed on initial examination of necrotizing fasciitis in patients who died and those who survived.. We retrospectively reviewed the medical records of 143 patients with surgically confirmed necrotizing fasciitis of the extremities over a period of 3.5 years at a tertiary hospital of southwest Taiwan. Differences in mortality, patient characteristics, laboratory findings, and hospital course were compared between patients who died and those who survived, and between patients with Gram-positive infections and those with Gram-negative infections.. A patient with a fungal infection died. Nine of the 58 patients in the Gram-positive group (15.5%) and 12 of the 60 cases in the Gram-negative group (20%) died. Hence a total of 22 patients died, giving a mortality rate of 15.4%. Hypotension, lower counts of total and segmented leukocytes, higher counts of banded leukocytes, and lower levels of serum albumin were significantly associated with mortality. Monomicrobial infections had a stake of 70.6%, and Vibrio spp were the predominant causative agents (26.6%).. Hypotensive shock, severe hypoalbuminemia, and increased counts of banded leukocytes can be considered the clinical and laboratory risk indicators to initiate early surgery and to predict mortality for all types of necrotizing fasciitis. The clinical characteristics of Gram-negative infections were more fulminant than those of Gram-positive infections.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ceftriaxone; Fasciitis, Necrotizing; Female; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Hospitals; Humans; Hypotension; Leukocyte Count; Leukocytes; Male; Medical Records; Middle Aged; Mycoses; Retrospective Studies; Risk Factors; Serum Albumin; Taiwan; Vibrio; Young Adult

A man in his early 80s presented to our emergency department with painless redness and swelling in his right leg. One week prior, he cleaned up floodwater in his basement after Hurricane Irene passed the Mid-Atlantic region of the USA in August 2011. Physical examination included large purple bullae and raised concern for necrotising fasciitis. Wound culture revealed a polymicrobial infection including Leclercia adecarboxylata.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Clindamycin; Cyclonic Storms; Diagnosis, Differential; Enterobacteriaceae; Enterobacteriaceae Infections; Fasciitis, Necrotizing; Floods; Humans; Leg; Male; Microbial Sensitivity Tests; Rare Diseases; Water Microbiology; Wound Infection

Topics: Aeromonas hydrophila; Anti-Bacterial Agents; Ceftriaxone; Epiglottitis; Fasciitis, Necrotizing; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Soft Tissue Infections

Topics: Aged; Anti-Bacterial Agents; Arthritis, Rheumatoid; Bacteremia; Bronchopneumonia; Ceftriaxone; Debridement; Dermatitis, Perioral; Diagnosis, Differential; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Emphysema; Fasciitis, Necrotizing; Fatal Outcome; Female; Heart Failure; Humans; Metronidazole; Respiration, Artificial; Streptococcus agalactiae; Vancomycin