Postgraduate Thesis: Patients with necrotizing fasciitis of extremities in ICU
| Title | Patients with necrotizing fasciitis of extremities in ICU |
|---|---|
| Authors | Hong, Kam-fai 康錦輝 |
| Issue Date | 2011 |
| Publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
| Abstract | Study objective: To evaluate the relationship between the adequacies of effective empirical antimicrobial therapy for severe necrotizing fasciitis involve extremities and clinical outcome among patients required ICU admission. Design: Retrospective Study Setting: A medical and surgical ICU (18beds) from a government tertiary referral hospital Results: Between 1 Jan 2006 to 31 December 2010, 32 patients were admitted consecutively to intensive care unit and diagnosed suffering from necrotizing fasciitis of their extremities. . The mean age was 63 + 11.96 year old. Most patients had documented preexisting medical conditions(75%); the most common was diabetes mellitus in 12 patients (37.5%). 26 patients (81.25%) admitted to our unit for post operative care, while the rest were admitted for treatment of acute organs failure. A single causative organism was identified in 27 patients (84.4%). The most common organisms isolated were Streptococcus Pyogenes, Vibrio Vulnificus and Aeromonas species. 75% of patients suffered from Vibrio species and 50% of Aeromonas species associated necrotizing fasciitis had contact history with contaminated seawater/fresh water. Ten patients (31.25%) patients in this study received ineffective empirical antimicrobial therapy. The prolong duration between admissions to administration of effective antibiotic (hrs) associated with amputation of their extremities (15.79 + 17.30 hrs verses 4.93 +/-11.99 hrs; with P value = 0.005). Patients received amputation also had significantly lower hemoglobin level (9.03 gm/dl +1.72 versus 10.46gm/dl +1.77; P value = 0.036) and received less operations (2.0 +1.03 verses 3.25 +1.95; P value =0.026). ICU mortality was 37.5%. ICU nonsurvivors had statistically lower hemoglobin level, received less operation, and had higher APACHE II scores. The crude mortality rate was 43.75%. Pre existing diabetes mellitus, acute renal failure that required renal replacement therapy, high APACHE II scores were factors associated with increase in hospital mortality. Conclusion: Prompt diagnosis and early administration of effective antibiotic, reduced morbidity. Base on the bacteriologic findings, early use of board spectrum empirical antibiotics to cover Streptococcus, Enterobacteriaceae; Vibrio and Aeromonas species in patients with history of seafood and fresh/seawater contacted is recommended. |
| Description | Thesis (P. Dip.)--University of Hong Kong, 2012. "This work is submitted to Faculty of Medicine of the University of Hong Kong in partial fulfillment of the requirements for the Postgraduate Diploma in Infectious Diseases, PDipID (HK)." Includes bibliographical references. |
| Degree | Postgraduate Diploma in Infectious Diseases |
| Subject | Necrotizing fasciitis. Anti-infective agents. |
| Dept/Program | Microbiology |
| dc.contributor.author | Hong, Kam-fai |
|---|---|
| dc.contributor.author | 康錦輝 |
| dc.date.accessioned | 2012-11-01T02:50:33Z |
| dc.date.available | 2012-11-01T02:50:33Z |
| dc.date.issued | 2011 |
| dc.description.abstract | Study objective: To evaluate the relationship between the adequacies of effective empirical antimicrobial therapy for severe necrotizing fasciitis involve extremities and clinical outcome among patients required ICU admission. Design: Retrospective Study Setting: A medical and surgical ICU (18beds) from a government tertiary referral hospital Results: Between 1 Jan 2006 to 31 December 2010, 32 patients were admitted consecutively to intensive care unit and diagnosed suffering from necrotizing fasciitis of their extremities. . The mean age was 63 + 11.96 year old. Most patients had documented preexisting medical conditions(75%); the most common was diabetes mellitus in 12 patients (37.5%). 26 patients (81.25%) admitted to our unit for post operative care, while the rest were admitted for treatment of acute organs failure. A single causative organism was identified in 27 patients (84.4%). The most common organisms isolated were Streptococcus Pyogenes, Vibrio Vulnificus and Aeromonas species. 75% of patients suffered from Vibrio species and 50% of Aeromonas species associated necrotizing fasciitis had contact history with contaminated seawater/fresh water. Ten patients (31.25%) patients in this study received ineffective empirical antimicrobial therapy. The prolong duration between admissions to administration of effective antibiotic (hrs) associated with amputation of their extremities (15.79 + 17.30 hrs verses 4.93 +/-11.99 hrs; with P value = 0.005). Patients received amputation also had significantly lower hemoglobin level (9.03 gm/dl +1.72 versus 10.46gm/dl +1.77; P value = 0.036) and received less operations (2.0 +1.03 verses 3.25 +1.95; P value =0.026). ICU mortality was 37.5%. ICU nonsurvivors had statistically lower hemoglobin level, received less operation, and had higher APACHE II scores. The crude mortality rate was 43.75%. Pre existing diabetes mellitus, acute renal failure that required renal replacement therapy, high APACHE II scores were factors associated with increase in hospital mortality. Conclusion: Prompt diagnosis and early administration of effective antibiotic, reduced morbidity. Base on the bacteriologic findings, early use of board spectrum empirical antibiotics to cover Streptococcus, Enterobacteriaceae; Vibrio and Aeromonas species in patients with history of seafood and fresh/seawater contacted is recommended. |
| dc.description.nature | published_or_final_version |
| dc.description | Thesis (P. Dip.)--University of Hong Kong, 2012. |
| dc.description | "This work is submitted to Faculty of Medicine of the University of Hong Kong in partial fulfillment of the requirements for the Postgraduate Diploma in Infectious Diseases, PDipID (HK)." |
| dc.description | Includes bibliographical references. |
| dc.description.thesisdiscipline | Microbiology |
| dc.description.thesislevel | Postgraduate diploma |
| dc.description.thesisname | Postgraduate Diploma in Infectious Diseases |
| dc.identifier.hkul | b4832058 |
| dc.identifier.uri | http://hdl.handle.net/10722/173741 |
| dc.language | eng |
| dc.publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
| dc.rights | Creative Commons: Attribution 3.0 Hong Kong License |
| dc.rights | The author retains all proprietary rights, (such as patent rights) and the right to use in future works. |
| dc.subject.lcsh | Necrotizing fasciitis. |
| dc.subject.lcsh | Anti-infective agents. |
| dc.title | Patients with necrotizing fasciitis of extremities in ICU |
| dc.type | PG_Thesis |