Table 1.
Clinical and laboratory characteristics, microbiology, and outcomes of patients with necrotizing fasciitis and severe cellulitis.
| Variables | Necrotizing Fasciitis (n = 61) |
Severe Cellulitis (n = 28) |
p-Value |
|---|---|---|---|
| Male sex | 31 (51) | 17 (61) | 0.39 |
| Age, mean years ± SD | 59 ± 16 | 59 ± 15 | 0.88 |
| Acquisition site of infection | 0.03 | ||
| Community-acquired infection | 41 (67) | 25 (89) | |
| Healthcare-associated infection | 20 (33) | 3 (11) | |
| Infection site | |||
| Leg | 41 (67) | 20 (71) | 0.69 |
| Arm | 13 (21) | 4 (14) | 0.43 |
| Abdomen & pelvis | 4 (7) | 1 (4) | >0.99 |
| Others | 3 (5) | 3 (11) | 0.37 |
| Underlying disease | |||
| Diabetes | 24 (39) | 9 (32) | 0.51 |
| Trauma | 22 (36) | 4 (14) | 0.04 |
| Tinea pedis or onychomycosis | 10 (16) | 9 (32) | 0.09 |
| Malignancy | 11 (18) | 6 (21) | 0.71 |
| Liver cirrhosis | 11 (18) | 1 (4) | 0.09 |
| Peripheral artery disease | 7 (12) | 0 | 0.09 |
| Chronic kidney disease | 6 (10) | 3 (11) | >0.99 |
| Lymphedema | 3 (5) | 1 (4) | >0.99 |
| Symptoms and signs | |||
| Pain and erythema | 61 (100) | 28 (100) | >0.99 |
| Fever | 42 (69) | 14 (50) | 0.09 |
| Discharge | 27 (44) | 4 (14) | 0.006 |
| Bullae | 25 (41) | 0 | <0.001 |
| Necrosis | 17 (28) | 0 | 0.002 |
| Altered mental status | 16 (26) | 1 (4) | 0.01 |
| Shock | 15 (25) | 1 (4) | 0.02 |
| Petechiae/hemorrhage | 11 (22) | 1 (4) | 0.05 |
| Metastatic infections | 6 (10) | 2 (7) | >0.99 |
| Laboratory findings | |||
| White blood cell, mean/mm3 ± SD | 14,000 ± 8500 | 10,000 ± 3800 | 0.05 |
| Hemoglobin, g/dL ± SD | 11.4 ± 2.6 | 13.5 ± 1.9 | 0.001 |
| Platelet, × 103/mm3 ± SD | 225 ± 131 | 217 ± 87 | 0.90 |
| INR ± SD | 1.3 ± 0.3 | 1.1 ± 0.2 | 0.07 |
| Bilirubin, mg/dL ± SD | 1.5 ± 2.9 | 0.9 ± 0.8 | 0.56 |
| Creatinine, mg/dL ± SD | 1.2 ± 1.0 | 1.0 ± 0.5 | 0.77 |
| Na, mEq/L ± SD | 135 ± 6 | 137 ± 4 | 0.02 |
| Glucose, mg/dL ± SD | 171 ± 124 | 153 ± 74 | 0.81 |
| C-reactive protein, mg/dL ± SD | 15.7 ± 11.4 | 9.4 ± 9.2 | 0.02 |
| Procalcitonin, ng/mL ± SD | 4.8 ± 5.3 | 6.7 ± 6.8 | 0.39 |
| Lactate, mmol/L ± SD | 2.5 ± 2.2 | 1.4 ± 0.2 | 0.54 |
| LRINEC score ± SD | 6.0 ± 3.6 | 3.1 ± 3.4 | 0.001 |
| High risk (≥8) | 24 (39) | 2 (7) | 0.002 |
| Moderate risk (6–7) | 9 (15) | 4 (14) | >0.99 |
| Low risk (≤5) | 28 (46) | 22 (79) | 0.004 |
| Microbiology | |||
| Overall culture positivity | 38 (62) | 5 (18) | <0.001 |
| Blood culture positivity | 18 (30) | 2 (7) | 0.02 |
| Wound culture positivity | 27 (44) | 3 (11) | 0.002 |
| Monobacterial infection | 30 (49) | 5 (18) | 0.005 |
| Polybacterial infection | 8 (13) | 0 | 0.05 |
| Staphylococcus aureus | 11 (18) | 1 (4) | 0.09 |
| Group A streptococcus | 5 (8) | 2 (7) | >0.99 |
| Group B and C streptococcus | 4 (7) | 1 (4) | >0.99 |
| Gram negative bacteria | 18 (30) | 1 (4) | 0.006 |
| Anaerobes | 0 | 0 | |
| Surgical debridement | 35 (57) | 0 | <0.001 |
| Amputation | 4 (11) | 0 | 0.30 |
| Interval between admission and surgery, mean days ± SD | 6 ± 8 | NA | NA |
| Second look operation | 18 (51) | 0 | 0.001 |
| Antibiotics | |||
| Total days of antibiotics use ± SD | 35 ± 25 | 20 ± 12 | 0.007 |
| Days of intravenous antibiotics use ± SD | 23 ± 19 | 8 ± 6 | <0.001 |
| Days of oral antibiotics use ± SD | 20 ± 16 | 13 ± 9 | 0.03 |
| Clinical outcomes | |||
| Intensive care unit admission | 16 (26) | 1 (4) | 0.01 |
| Mechanical ventilator | 10 (16) | 0 | 0.03 |
| Relapse within 1 month | 10 (16) | 1 (4) | 0.16 |
| In hospital mortality | 14 (23) | 0 | 0.004 |
NOTE. Data are presented as the number (%) of patients unless otherwise indicated. Abbreviations: INR = international normalized ratio; LRINEC = laboratory risk indicator for necrotizing fasciitis; NA = not available; SD = standard deviation.