Tsung-Yu Huang1,2,3, Yao-Hung Tsai2,4,5, Liang-Tseng Kuo4,6, Wei-Hsiu Hsu2,4,5, Cheng-Ting Hsiao6,7, Chien-Hui Hung1,2, Wan-Yu Huang3,8, Han-Ru Wu9, Hui-Ju Chuang10, Yen-Yao Li4,6, Kuo-Ti Peng11,12,13. 1. Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan. 2. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. 3. Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan. 4. Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West section, Chia-Pu Road, Pu-Zih city, Chia-Yi County, Taiwan, 61363. 5. Department of Chinese Medicine, School of Medicine, Chang Gung University, Chiayi, Taiwan. 6. College of Medicine, Chang Gung University, Taoyuan, Taiwan. 7. Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan. 8. Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan. 9. Department of Pharmacy, Chang Gung Memorial Hospital, Chiayi, Taiwan. 10. Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan. 11. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. mr3497@cgmh.org.tw. 12. Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West section, Chia-Pu Road, Pu-Zih city, Chia-Yi County, Taiwan, 61363. mr3497@cgmh.org.tw. 13. Department of Chinese Medicine, School of Medicine, Chang Gung University, Chiayi, Taiwan. mr3497@cgmh.org.tw.
Abstract
STUDY OBJECTIVE: Necrotizing fasciitis (NF) is an uncommon life-threatening necrotizing skin and soft tissue infection. Bullae are special skin manifestations of NF. This study was conducted to analyze the differences between different types of bullae of limbs with NF for providing the information to emergency treatment. METHODS: From April 2015 to August 2018, patients were initially enrolled based on surgical confirmation of limbs with NF. According to the presence of different bullae types, patients were divided into no bullae group (Group N), serous-filled bullae group (Group S), and hemorrhagic bullae group (Group H). Data such as demographics, clinical outcomes, microbiological results, presenting symptoms/signs, and laboratory findings were compared among these groups. RESULTS: In total, 187 patients were collected, with 111 (59.4%) patients in Group N, 35 (18.7%) in Group S, and 41 (21.9%) in Group H. Group H had the highest incidence of amputation, required intensive care unit care, and most patients infected with Vibrio species. In Group N, more patients were infected with Staphylococcus spp. than Group H. In Group S, more patients were infected with β-hemolytic Streptococcus than Group H. Patients with bacteremia, shock, skin necrosis, anemia, and longer prothrombin time constituted higher proportions in Group H and S than in Group N. CONCLUSIONS: In southern Taiwan, patients with NF accompanied by hemorrhagic bullae appear to have more bacteremia, Vibrio infection, septic shock, and risk for amputation. If the physicians at the emergency department can detect for the early signs of NF as soon as possible, and more patient's life and limbs may be saved.
STUDY OBJECTIVE: Necrotizing fasciitis (NF) is an uncommon life-threatening necrotizing skin and soft tissue infection. Bullae are special skin manifestations of NF. This study was conducted to analyze the differences between different types of bullae of limbs with NF for providing the information to emergency treatment. METHODS: From April 2015 to August 2018, patients were initially enrolled based on surgical confirmation of limbs with NF. According to the presence of different bullae types, patients were divided into no bullae group (Group N), serous-filled bullae group (Group S), and hemorrhagic bullae group (Group H). Data such as demographics, clinical outcomes, microbiological results, presenting symptoms/signs, and laboratory findings were compared among these groups. RESULTS: In total, 187 patients were collected, with 111 (59.4%) patients in Group N, 35 (18.7%) in Group S, and 41 (21.9%) in Group H. Group H had the highest incidence of amputation, required intensive care unit care, and most patients infected with Vibrio species. In Group N, more patients were infected with Staphylococcus spp. than Group H. In Group S, more patients were infected with β-hemolytic Streptococcus than Group H. Patients with bacteremia, shock, skin necrosis, anemia, and longer prothrombin time constituted higher proportions in Group H and S than in Group N. CONCLUSIONS: In southern Taiwan, patients with NF accompanied by hemorrhagic bullae appear to have more bacteremia, Vibrio infection, septic shock, and risk for amputation. If the physicians at the emergency department can detect for the early signs of NF as soon as possible, and more patient's life and limbs may be saved.