FORREST GN, JOSHI M, BOCHICCHIO G, BRULL R, CAPLAN E, SCALEA T; Interscience Conference on Antimicrobial Agents and Chemotherapy (41st : 2001 : Chicago, Ill.).
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2001 Dec 16-19; 41: abstract no. L-1478.
R Adams Cowley Shock Trauma Center, Univ of Maryland, Baltimore, MD
BACKGROUND: PNF is a severe synergistic infection requiring aggressive surgery and appropriate antibiotic therapy. There is a high mortality rate associated with this disease. METHOD: The records were reviewed on all patients who were admitted to the Shock Trauma Center between 1/2000 and 1/2001 with PNF. The infecting organisms from the initial surgery, the initial antibiotic therapy selected, the mortality and demographic data were collected from these patients. RESULTS: There were 48 patients admitted with a surgical diagnosis of PNF. 56% were male and 60% were Caucasian. 73% were transferred from another facility where the average length of stay was 3 days. The average stay at Shock Trauma was 30 days (Range 5 to 72 days). 10 patients died from their illness. The frequency of organisms from the initial cultures were: Bacteroides sp. 80%, Enterococcal sp. 70%, all streptococcal sp 40%, Gram Negative Rods (GNR) 40% and S. aureus 15%. (GNR - either E. coli, Klebsiella, Pseudomonas, Proteus, Morganella, Serratia or Enterobacter). 35% of patients received 2 antibiotics, 25% received just 1 antibiotic. The rest received between 3 and 7 antibiotics. Initial antibiotics covered Bacteroides sp. 41/48 (85%), Enterococcus 35/48 (73%) and GNR 47/48 (98%) of the time. The deaths were notable for the absence of coverage for anaerobic or enterococcal organisms. This is evidenced by 7/10 patients who died who were given either a quinolone alone or a quinolone with an aminoglycoside or a quinolone with either clindamycin or metronidazole. CONCLUSION: PNF is a polymicrobial infection with the predominant organism being anaerobes and enterococcus. Early antibiotic selection should incorporate coverage for all infecting organisms. Quinolone therapy alone or with an aminoglycoside is inadequate in the treatment of PNF.
Publication Types:
Keywords:
- Aminoglycosides
- Anti-Bacterial Agents
- Clindamycin
- Culture
- Enterobacter
- Enterococcus
- Fasciitis, Necrotizing
- Gram-Negative Bacteria
- Humans
- Klebsiella
- Male
- Metronidazole
- mortality
Other ID:
UI: 102270529
From Meeting Abstracts