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Background <p>Monomicrobial necrotizing fasciitis (NF) caused by <i>Escherichia coli</i> (<i>E. coli</i>), is exceptionally uncommon and has been reported to be associated with death. The purposes of this study were to elucidate the specific characteristics of <i>E. coli</i> NF, to compare the independent predictors related to surgical outcomes between the monomicrobial and polymicrobial groups, and to investigate antibiotics usage and resistance.</p> Methods <p>Twenty-five NF patients who revealed monomicrobial <i>E. coli</i> infection and polymicrobial NF with only <i>E. coli</i> growing heavy and predominant in wound and blood cultures were retrospectively reviewed over a 16-year period. Differences in in-hospital mortality, clinical outcomes, laboratory findings, presentation of bacteremia, antibiotics resistance and presentation of hemorrhagic bullae were compared between the monomicrobial and polymicrobial NF groups.</p> Results <p>Four of 10 patients (40%) with monomicrobial infections and one of 15 patients (6.7%) with polymicrobial infections died. The patients in the monomicrobial group had a significantly higher incidence of bacteremia, shock, lower total white blood cell (WBC) counts, higher banded forms, higher lactate, higher creatinine and lower platelet counts than those in the polymicrobial group. No significant difference was observed for escalation of antibiotics among the death and the survival patients while ineffective empirical antimicrobial using at initial admission.</p> Conclusion <p>Monomicrobial NF caused by <i>E. coli</i> was rare and revealed more fulminating and higher mortality than polymicrobial NF. We confirmed that those factors including shock, bacteremia, lower WBC counts, higher banded leukocyte counts, lower segmented leukocyte counts, higher lactate levels, and lower albumin levels were associated mortality in <i>E. coli</i> NF. Fourteen patients (56%) confirmed antibiotics resistant <i>E. coli</i> stains, and 9 patients were found ineffective empirical antimicrobial usage, and thus early application of effective antimicrobial agents with escalation therapy may improve the outcomes of <i>E. coli</i> NF patients after emergent surgery.</p>

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Assessing the impact of bacteremia and antibiotic resistance on mortality in patients with monomicrobial and polymicrobial Escherichia coli necrotizing fasciitis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月2日

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  • Tsung-Yu Huang,
  • Hung-Yen Chen,
  • Yu-Chieh Hsieh,
  • Jiun-Liang Chen,
  • Shu-Fang Kuo,
  • Kuo-Chin Huang,
  • Yao-Hung Tsai

摘要

Background

Monomicrobial necrotizing fasciitis (NF) caused by Escherichia coli (E. coli), is exceptionally uncommon and has been reported to be associated with death. The purposes of this study were to elucidate the specific characteristics of E. coli NF, to compare the independent predictors related to surgical outcomes between the monomicrobial and polymicrobial groups, and to investigate antibiotics usage and resistance.

Methods

Twenty-five NF patients who revealed monomicrobial E. coli infection and polymicrobial NF with only E. coli growing heavy and predominant in wound and blood cultures were retrospectively reviewed over a 16-year period. Differences in in-hospital mortality, clinical outcomes, laboratory findings, presentation of bacteremia, antibiotics resistance and presentation of hemorrhagic bullae were compared between the monomicrobial and polymicrobial NF groups.

Results

Four of 10 patients (40%) with monomicrobial infections and one of 15 patients (6.7%) with polymicrobial infections died. The patients in the monomicrobial group had a significantly higher incidence of bacteremia, shock, lower total white blood cell (WBC) counts, higher banded forms, higher lactate, higher creatinine and lower platelet counts than those in the polymicrobial group. No significant difference was observed for escalation of antibiotics among the death and the survival patients while ineffective empirical antimicrobial using at initial admission.

Conclusion

Monomicrobial NF caused by E. coli was rare and revealed more fulminating and higher mortality than polymicrobial NF. We confirmed that those factors including shock, bacteremia, lower WBC counts, higher banded leukocyte counts, lower segmented leukocyte counts, higher lactate levels, and lower albumin levels were associated mortality in E. coli NF. Fourteen patients (56%) confirmed antibiotics resistant E. coli stains, and 9 patients were found ineffective empirical antimicrobial usage, and thus early application of effective antimicrobial agents with escalation therapy may improve the outcomes of E. coli NF patients after emergent surgery.