TABLE 2.

Cases of monomicrobial necrotizing fasciitis caused by Klebsiella pneumoniae, where detailed data were available

Author	Year	Country	Location	Age	Sex	Risk factors	Comorbidities	Microbiology	Management	Outcome
Oishi et al53	2008	Japan	Lower extremities	73	M	Ingestion of raw fish	Hepatocellular cell carcinoma, liver cirrhosis, and chronic renal failure	Klebsiella oxytoca	Palliative care	Died
Kohler et al48	2007	USA	Left groin, thigh, and knee	50	M	Cambodian, recent travel to Cambodia 6 mopreviously	Chronic hepatitis B infection, advancedcirrhosis,emphysema	Wound, blood culture grew K. pneumoniae sensitive to cephalosporins, gentamicin identified as having K1 capsular antigen	Ceftazidime, meropenem	Died
Chen et al49	2006	Taiwan	Iliac and gluteal muscles	74	M	Complicated emphysematous cystitis	Diabetes mellitus	K. pneumoniae was cultured from blood, urine, and pus	Intravenous antibiotics and surgical debridement of his left hip	Survived
Mazita et al50	2005	Malaysia	Neck	65	F	Indian, 1-mo history of increased neck swelling	Diabetes mellitus	Klebsiella spp. (tissue)	Surgical debridement, widespectrum antibiotics	Survived
Wong et al51	2004	Singapore	Left neck, chest wall, and urinarytract	43	M	None	Diabetes mellitus	Klebsiella strain susceptible to ceftriaxone, cephalexin, and gentamicin was isolated from blood, tissue, and fluid cultures and, subsequently, from urine, methicillin-resistant Staphylococcus aureus from tissue cultures	Two surgical debridements, parenteral ceftriaxone, metronidazole, and vancomycin, followed by oral cefuroxime (74 d)	Survived
Wong et al51	2004	Singapore	Left buttock and thigh and urinarytract	40	M	None	Diabetes mellitus	Tissue, blood, and urine cultures grew a Klebsiella strain susceptible to ceftriaxone, cephalexin, and gentamicin	Two debridements, ceftriaxone and gentamicin for 32 d, followed by oral cefuroxime for a total of 52 d	Survived
Wong et al51	2004	Singapore	Right popliteal fossa and right lower limb, right lobe of liver, and right kidney	56	M	Pain and swelling of right knee and calf for 2 d before admission	Diabetes mellitus, chronic liver disease, hepatitis B	Tissue, blood, and urine culture Klebsiella strain susceptible to ceftriaxone, cephalexin, and gentamicin	Two surgical debridements, ceftriaxone, gentamicin, and metronidazole for a total of 152 d	Survived
Wong et al51	2004	Singapore	Right posterior thigh	76	F	None	Diabetes mellitus	Tissue and blood cultures both grew a Klebsiella strain that was susceptible to ceftriaxone, cephalexin, and gentamicin	Surgical debridement. Parenteral penicillin, cloxacillin, and gentamicin (patient succumbed within 48 hr)	Died, toxic shock syndrome: developed septic shock,ARF and DIC
Al-Ammar andMaqbool52	2004	Saudi Arabia	Left face and cervical area	50	M	NR	Diabetes mellitus, chronic renal failure	Tissue culture revealed a heavy growth of Klebsiella aeruginosa sensitive to many antimicrobial agents, including ceftriaxone and cefuroxime	Two surgical debridements. Parenteral ceftriaxone, clindamycin for 3 wk, and oral cefuroxime for 10 d	Survived with residual permanent facial paralysis
Parasakthi et al47	2000	Malaysia	Perineum	7	M	Testicular biopsy	Acute myelogenous leukemia	Multidrug-resistant K.pneumoniae from blood and wound culture resistant to ceftazidime, sensitive to imipenem and ciprofloxacin, and confirmed to be extended-spectrum beta-lactamase producers	Debridement, ceftazidime, and amikacin	NR
Ho et al41	2000	Hong Kong	Both lower limbs, spontaneous bacterial peritonitis of ascitic fluid	52	M	Spontaneous bacterial peritonitis 4 d before admission	Diabetes mellitus, liver cirrhosis	Blood cultures, tissue cultures from the lower limb grew K.pneumoniae that was susceptible to cefoperazone/sulbactam, amoxicillin/clavulanate, and ofloxacin	Surgical debridement, amoxicillin/clavunate, and ofloxacin	Died
Hu et al5	1999	Taiwan	Left leg, left eye, abscesses in the liver, both kidneys and pancreas	71	F	None	Diabetes mellitus	K. pneumoniae tissue culture from the lower limb and pus from the liver abscess The two isolates belonged to capsular serotype K1	Multiple debridements of the lower limb and evisceration of the left eye, ceftriaxone	Survived
Hu et al5	1999	Taiwan	Left lower limb, liver abscesses	40	M	None	Diabetes mellitus	K. pneumoniae tissue cultures of the left lower limb and bloodcultures	Cefazolin and gentamicin (37 d)	Survived
Dylewski andDylewski6	1998	Canada	Both lower limbs and liver abscess	47	M	Native of India, sailor, his ship with recent stops in Singapore, South Africa, and Morocco	Diabetes mellitus	K. pneumoniae tissue cultures from the left and right lower limb, pus from liver abscess (resistant to cephalothin but susceptible to ceftriaxone and ciprofloxacin) and blood cultures	Two surgical debridements, ciprofloxacin, ceftriaxone	Survived
Wang et al42	1998	Taiwan	Right leg	NR	NR	NR	Diabetes mellitus	K pneumoniae resistant to ampicillin and ticarcillin/ carbenicillin and susceptible to all other antibiotics	Surgical debridement, cefazolin, gentamicin	Died
Ozkan et al43	1997	Turkey	Perianal region	10 d	M	Repeated rectal temperature measurements	None	K. pneumoniae tissue culture from perianal area or wound.Negative blood cultures	Ampicillin-sulbactam, ceftazidime followed by imipenem and netilmicin (2 wk). Surgical debridement	Survived
Chou and Kou44	1996	China	Thigh	60	M	Liver abscess	Diabetes mellitus	K. pneumoniae liver aspirate, blood cultures	NR	Survived