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Local Trends of Antibiotic Prescriptions for Necrotizing Fasciitis Patients in Two Tertiary Care Hospitals in Central Malaysia

Background: Necrotizing fasciitis (NF) is a rapidly progressive inflammatory infection of the soft tissue (also known as the fascia) with a secondary necrosis of the subcutaneous tissues, leading to a systemic inflammatory response syndrome (SIRS), shock and eventually death despite the availability...

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Autores principales: Rampal, Sanjiv, Ganesan, Thanusha, Sisubalasingam, Narresh, Neela, Vasantha Kumari, Tokgöz, Mehmet Ali, Arunasalam, Arun, Ab Halim, Mohd Asyraf Hafizuddin, Shamsudin, Zulfahrizzat Bin, Kumar, Suresh, Sinniah, Ajantha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470198/
https://www.ncbi.nlm.nih.gov/pubmed/34572702
http://dx.doi.org/10.3390/antibiotics10091120
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author Rampal, Sanjiv
Ganesan, Thanusha
Sisubalasingam, Narresh
Neela, Vasantha Kumari
Tokgöz, Mehmet Ali
Arunasalam, Arun
Ab Halim, Mohd Asyraf Hafizuddin
Shamsudin, Zulfahrizzat Bin
Kumar, Suresh
Sinniah, Ajantha
author_facet Rampal, Sanjiv
Ganesan, Thanusha
Sisubalasingam, Narresh
Neela, Vasantha Kumari
Tokgöz, Mehmet Ali
Arunasalam, Arun
Ab Halim, Mohd Asyraf Hafizuddin
Shamsudin, Zulfahrizzat Bin
Kumar, Suresh
Sinniah, Ajantha
author_sort Rampal, Sanjiv
collection PubMed
description Background: Necrotizing fasciitis (NF) is a rapidly progressive inflammatory infection of the soft tissue (also known as the fascia) with a secondary necrosis of the subcutaneous tissues, leading to a systemic inflammatory response syndrome (SIRS), shock and eventually death despite the availability of current medical interventions. The clinical management of this condition is associated with a significant amount of morbidity with a high rate of mortality. The prognosis of the disease is affected by multiple factors, which include the virulence of the causative pathogen, local host immunity, local wound factors and empirical antibiotics used. The local trends in the prescription of empirical antibiotics are often based on clinical practice guidelines (CPG), the distribution of the causative microorganism and the cost-effectiveness of the drug. However, there appears to be a paucity of literature on the empirical antibiotic of choice when dealing with necrotizing fasciitis in the clinical setting. This paper will outline common causative microorganisms and current trends of prescription in two tertiary centres in Central Malaysia. Methods: This was a cross-sectional study using retrospective data of patients treated for NF collected from two tertiary care hospitals (Hospital Seremban and Hospital Ampang) in Central Malaysia. A total of 420 NF patients were identified from the five years of retrospective data obtained from the two hospitals. Results: The top three empirical antibiotics prescribed are ampicillin + sulbactam (n = 258; 61.4%), clindamycin (n = 55; 13.1%) and ceftazidime (n = 41; 9.8%). The selection of the antibiotic significantly impacts the outcome of NF. The top three causative pathogens for NF are Streptococcus spp. (n = 79; 18.8%), Pseudomonas aeruginosa (n = 61; 14.5%) and Staphylococcus spp. (n = 49; 11.7%). The patients who received antibiotics had 0.779 times lower chances of being amputated. Patients with a lower laboratory risk indicator for necrotizing fasciitis (LRINEC) score had 0.934 times lower chances of being amputated. Conclusions: In this study, the most common empirical antibiotic prescribed was ampicillin + sulbactam followed by clindamycin and ceftazidime. The antibiotics prescribed lower the risk of having an amputation and, hence, a better prognosis of the disease. Broad-spectrum empirical antibiotics following surgical debridement reduce the mortality rate of NF.
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spelling pubmed-84701982021-09-27 Local Trends of Antibiotic Prescriptions for Necrotizing Fasciitis Patients in Two Tertiary Care Hospitals in Central Malaysia Rampal, Sanjiv Ganesan, Thanusha Sisubalasingam, Narresh Neela, Vasantha Kumari Tokgöz, Mehmet Ali Arunasalam, Arun Ab Halim, Mohd Asyraf Hafizuddin Shamsudin, Zulfahrizzat Bin Kumar, Suresh Sinniah, Ajantha Antibiotics (Basel) Article Background: Necrotizing fasciitis (NF) is a rapidly progressive inflammatory infection of the soft tissue (also known as the fascia) with a secondary necrosis of the subcutaneous tissues, leading to a systemic inflammatory response syndrome (SIRS), shock and eventually death despite the availability of current medical interventions. The clinical management of this condition is associated with a significant amount of morbidity with a high rate of mortality. The prognosis of the disease is affected by multiple factors, which include the virulence of the causative pathogen, local host immunity, local wound factors and empirical antibiotics used. The local trends in the prescription of empirical antibiotics are often based on clinical practice guidelines (CPG), the distribution of the causative microorganism and the cost-effectiveness of the drug. However, there appears to be a paucity of literature on the empirical antibiotic of choice when dealing with necrotizing fasciitis in the clinical setting. This paper will outline common causative microorganisms and current trends of prescription in two tertiary centres in Central Malaysia. Methods: This was a cross-sectional study using retrospective data of patients treated for NF collected from two tertiary care hospitals (Hospital Seremban and Hospital Ampang) in Central Malaysia. A total of 420 NF patients were identified from the five years of retrospective data obtained from the two hospitals. Results: The top three empirical antibiotics prescribed are ampicillin + sulbactam (n = 258; 61.4%), clindamycin (n = 55; 13.1%) and ceftazidime (n = 41; 9.8%). The selection of the antibiotic significantly impacts the outcome of NF. The top three causative pathogens for NF are Streptococcus spp. (n = 79; 18.8%), Pseudomonas aeruginosa (n = 61; 14.5%) and Staphylococcus spp. (n = 49; 11.7%). The patients who received antibiotics had 0.779 times lower chances of being amputated. Patients with a lower laboratory risk indicator for necrotizing fasciitis (LRINEC) score had 0.934 times lower chances of being amputated. Conclusions: In this study, the most common empirical antibiotic prescribed was ampicillin + sulbactam followed by clindamycin and ceftazidime. The antibiotics prescribed lower the risk of having an amputation and, hence, a better prognosis of the disease. Broad-spectrum empirical antibiotics following surgical debridement reduce the mortality rate of NF. MDPI 2021-09-17 /pmc/articles/PMC8470198/ /pubmed/34572702 http://dx.doi.org/10.3390/antibiotics10091120 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Rampal, Sanjiv
Ganesan, Thanusha
Sisubalasingam, Narresh
Neela, Vasantha Kumari
Tokgöz, Mehmet Ali
Arunasalam, Arun
Ab Halim, Mohd Asyraf Hafizuddin
Shamsudin, Zulfahrizzat Bin
Kumar, Suresh
Sinniah, Ajantha
Local Trends of Antibiotic Prescriptions for Necrotizing Fasciitis Patients in Two Tertiary Care Hospitals in Central Malaysia
title Local Trends of Antibiotic Prescriptions for Necrotizing Fasciitis Patients in Two Tertiary Care Hospitals in Central Malaysia
title_full Local Trends of Antibiotic Prescriptions for Necrotizing Fasciitis Patients in Two Tertiary Care Hospitals in Central Malaysia
title_fullStr Local Trends of Antibiotic Prescriptions for Necrotizing Fasciitis Patients in Two Tertiary Care Hospitals in Central Malaysia
title_full_unstemmed Local Trends of Antibiotic Prescriptions for Necrotizing Fasciitis Patients in Two Tertiary Care Hospitals in Central Malaysia
title_short Local Trends of Antibiotic Prescriptions for Necrotizing Fasciitis Patients in Two Tertiary Care Hospitals in Central Malaysia
title_sort local trends of antibiotic prescriptions for necrotizing fasciitis patients in two tertiary care hospitals in central malaysia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470198/
https://www.ncbi.nlm.nih.gov/pubmed/34572702
http://dx.doi.org/10.3390/antibiotics10091120
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