File Download
Supplementary

postgraduate thesis: Patients with necrotizing fasciitis of extremities in ICU

TitlePatients with necrotizing fasciitis of extremities in ICU
Authors
Issue Date2011
PublisherThe University of Hong Kong (Pokfulam, Hong Kong)
Citation
Hong, K. [康錦輝]. (2011). Patients with necrotizing fasciitis of extremities in ICU. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR.
AbstractStudy 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.
DescriptionThesis (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.
DegreePostgraduate Diploma in Infectious Diseases
SubjectNecrotizing fasciitis.
Anti-infective agents.
Dept/ProgramMicrobiology
Persistent Identifierhttp://hdl.handle.net/10722/173741

 

DC FieldValueLanguage
dc.contributor.authorHong, Kam-faien_HK
dc.contributor.author康錦輝zh_HK
dc.date.accessioned2012-11-01T02:50:33Z-
dc.date.available2012-11-01T02:50:33Z-
dc.date.issued2011en_US
dc.identifier.citationHong, K. [康錦輝]. (2011). Patients with necrotizing fasciitis of extremities in ICU. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR.-
dc.identifier.urihttp://hdl.handle.net/10722/173741-
dc.descriptionThesis (P. Dip.)--University of Hong Kong, 2012.en_US
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)."en_US
dc.descriptionIncludes bibliographical references.en_US
dc.description.abstractStudy 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.en_US
dc.languageengen_US
dc.publisherThe University of Hong Kong (Pokfulam, Hong Kong)en_US
dc.rightsCreative Commons: Attribution 3.0 Hong Kong Licenseen_US
dc.rightsThe author retains all proprietary rights, (such as patent rights) and the right to use in future works.en_US
dc.subject.lcshNecrotizing fasciitis.en_US
dc.subject.lcshAnti-infective agents.en_US
dc.titlePatients with necrotizing fasciitis of extremities in ICUen_HK
dc.typePG_Thesisen_US
dc.identifier.hkulb4832058en_US
dc.description.thesisnamePostgraduate Diploma in Infectious Diseasesen_US
dc.description.thesislevelPostgraduate diplomaen_US
dc.description.thesisdisciplineMicrobiologyen_US
dc.description.naturepublished_or_final_versionen_US

Export via OAI-PMH Interface in XML Formats


OR


Export to Other Non-XML Formats