Necrotizing Fasciitis Caused by Aeromonas Species-A Case Series in a Single Institution

產氣單胞菌引起的壞死性筋膜炎－奇美醫學中心的病例分析

洪敏翔(Min-Hsiang Hung) ； 蘇柏安(Bo-An Su) ； 林聿山(Yu-San Lin) ； 劉澄(Cheng Liu) ； 陳俊嘉(Chun-Chia Chen) ； 葉敬淳(Chin-Choon Yeh) ； 周惠能(Wai-Nang Chao) ； 黃國峯(Kuo-Feng Huang)

《臺灣整形外科醫學會雜誌》 23卷2期 (2014/06) Pp. 149-160

摘要

背景：產氣單胞菌為革蘭氏陰性桿菌，主要存在於水生環境，如淡水、汙水、鹹水、土壤、自來水或非糞土的有機肥料中。相較於其他菌種起來，產氣單胞菌造成的壞死性筋膜炎並不常見，然而卻有極高的死亡率。更進一步的說，在臨床上，並不容易以臨床症狀及表現來區分產氣單胞菌引起的壞死性筋膜炎和其他非產氣單胞菌引起的壞死性筋膜炎。目的及目標：在此篇文章中，我們提出我們治療產氣單胞菌引起的壞死性筋膜炎的臨床經驗，並分析產氣單胞菌和非產氣單胞菌引起的壞死性筋膜炎在臨床表現的差別。材料及方法：我們分析奇美醫學中心七年期間472個壞死性筋膜炎的病人，記載病人的基本資料、影響部位、臨床表現、實驗室檢查數值、微生物培養結果、抗生素使用、手術介入時間及預後。並比較以上資料在產氣單胞菌和非產氣單胞菌引起的壞死性筋膜炎的差別。結果：在472個病人中，有21個病人為產氣單胞菌感染，而另外451個病人為非產氣單胞菌感染。產氣單胞菌引起的壞死性筋膜炎死亡率為38.1%（n = 8），入院時有休克表現及延長的活化部分凝血活酶時間和產氣單胞菌感染引起的壞死性筋膜炎間呈現統計上有意義的相關聯。結論：當病人有土壤、淡水或鹹水的接觸史，在臨床上又合併有休克及及延長的活化部分凝血活酶時間，產氣單胞菌感染應該高度的懷疑。早期診斷、盡早手術介入及合併使用第三代頭孢素和四環黴素可以有效降低產氣單胞菌造成的壞死性筋膜炎。

並列摘要

Background: Aeromonas species are Gram-negative bacilli that thrive in aquatic environments, including sewage, fresh or brackish water, soil, tap water, and nonfecal organic materials. Necrotizing fasciitis (NF) caused by Aeromonas species is less common than NF due to other bacterial species; however, it is associated with higher morbidity and mortality rates. Furthermore, it is difficult to differentiate between NF caused by Aeromonas species and NF due to other types of bacteria based on clinical symptoms alone. Aims and Objectives: The purpose of the study is to present our clinical experience treating patients with this disease at a single institution and to differentiate clinical presentation between NF caused by Aeromonas species and NF due to other types of bacteria. Material and Methods: In this retrospective study, we enrolled all patients (n = 472) with a diagnosis of NF who had been treated at a single medical center during a seven-year period. Data on patient characteristics, affected sites, clinical symptoms, results of microbiological tests, antibiotic therapy, surgical intervention, and outcomes were obtained from the medical records and were compared between the group of patients with Aeromonas NF and the group of patients with non-Aeromonas NF. Results: During the study period, 21 patients had necrotizing fasciitis due to Aeromonas species and 451 had NF due to other types of bacteria. The overall mortality rate among patients with Aerononas infection was 38.1% (n = 8). Shock at admission, and prolonged activated partial thromboplastin time were significantly associated with Aeromonas infections in the univariate analysis. Conclusions: Based on our findings, Aeromonas infection may be considered in patients with ahistory of exposure to soil, fresh water, or brackish water who present with a fulminant clinical course accompanied by shock and prolonged aPTT. Early diagnosis, prompt surgical intervention, and administration of appropriate antibiotic therapy comprising a third-generation cephalosporin combined with doxycycline or minocycline can help improve survival and minimize morbidity in patients with necrotizing fasciitis caused by Aeromonas species.

並列關鍵字

Aeromonas ； necrotizing fasciitis