The microbiological profile of necrotising fasciitis at a secondary level hospital in Gauteng

Abstract

Background: Necrotising fasciitis (NF) is a fulminant soft tissue infection that requires timely diagnosis, urgent surgical debridement, and appropriate antimicrobial therapy. The choice of empiric antimicrobial therapy depends on the microorganisms cultured and the antimicrobial resistance profile of the institution. Necrotising fasciitis has not been studied in our setting. Objectives: The aim of the study was to audit the microbiological profile of NF and antimicrobial susceptibility profile. Method: This was a retrospective study in a secondary level hospital from the period of 2014–2020. The patients’ demographic data, clinical features, location of infection, comorbidities, laboratory and microbiological profiles were analysed. Results: There were 53 patients during 2014–2020 with median age of 45.5 (38.5–56.0) years. The majority of the patients were males (35 [66.04%]), had no comorbidities (25 [47.17%]), and the lower limb was the most common anatomic site (17 [32.08%]). Type II (monomicrobial) NF was the predominant type (31 [58.49%]). Staphylococcus aureus was the most prevalent Gram-positive bacteria (18 [38%]) and Escherichia coli, the main species isolated in the Gram-negative bacteria (14 [36%]) with susceptibility to cloxacillin (94%) and amoxicillin and/or clavulanic acid (92%), respectively. Conclusion: Staphylococcus aureus and Escherichia coli were the most common bacteria with low rate of antimicrobial resistance. Amoxicillin and/or clavulanic acid and an adjunctive clindamycin are appropriate antimicrobial therapy for empiric treatment for NF in our setting. Contribution: Amoxicillin and/or clavulanic acid and an adjunctive clindamycin can be used as an empiric treatment for NF.

Keywords

• necrotising fasciitis
• polymicrobial
• monomicrobial
• antimicrobial sensitivity
• antimicrobial resistance