Vol.69 No.2 March 2021
A retrospective study of the causative organisms and empiric therapy for necrotizing soft tissue infections in Japan
1)Department of General Medicine, Kagoshima Seikyo Hospital, 5-20-10 Taniyamachuo, Kagoshima, Kagoshima, Japan
2)Department of Infection Control and Prevention, Saga University Hospital
Abstract
Necrotizing Soft Tissue Infection (NSTI) is a serious soft tissue infection that is associated with a high mortality rate. We often use broad-spectrum empiric antibiotic therapy for NSTIs, even though this increases the risk of antibiotic resistance. Therefore, we conducted a retrospective cohort study of 148 adult patients with NSTIs at Saga University Hospital between January 2011 and November 2018, to better assess the validity of empiric antibiotic therapy for NSTIs. Of the 148 patients, a total of 12 items were evaluated in 66 patients. Out of the 66 patients, 41 patients (62.1%) were male, and 31 (46.9%) had underlying diabetes mellitus. The most common site of involvement was the lower extremities (32 cases), and the overall in-hospital mortality rate within the first 28 days of hospital admission was 19.7% (13 cases). As initial empirical antibiotic therapy, carbapenems and tazobactam/piperacillin were used in 17 (25.8%) cases each, and antibiotics against methicillin-resistant Staphylococcus aureus (MRSA) were used in 26 (39.4%) cases. Bacteroides fragilis and Escherichia coli (14 patients each) were the most commonly isolated pathogens from closed pus specimens. Extended-spectrum β-lactamase (ESBL)-producing isolates were identified in 5 (7.6%) cases and MRSA in 8 (12.1%) cases. Although the results of this study were similar to those reported previously, the increase in the rate of community infections caused by ESBL-producing E. coli was concerning. Thus, broad-spectrum antimicrobials may not be needed in the majority of NSTIs, and further studies are needed to review the customary use of broad-spectrum antimicrobials and allow for appropriate selection of antimicrobials.
Key word
necrotizing soft tissue infection, empiric chemotherapy, diabetes mellitus, anaerobic bacteria, LRINEC score
Received
July 14, 2020
Accepted
November 27, 2020
Jpn. J. Chemother. 69 (2): 123-130, 2021
