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.

中文翻译：

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马来西亚中部两家三级医院为坏死性筋膜炎患者开具抗生素处方的当地趋势

背景：坏死性筋膜炎 (NF) 是一种快速进展的软组织 (也称为筋膜) 炎症感染，伴有皮下组织继发性坏死，导致全身炎症反应综合征 (SIRS)、休克和最终死亡，尽管当前医疗干预措施的可用性。这种情况的临床管理与大量发病率和高死亡率相关。该疾病的预后受多种因素影响，包括致病病原体的毒力、局部宿主免疫、局部伤口因素和经验性使用的抗生素。经验性抗生素处方的当地趋势通常基于临床实践指南 (CPG)、致病微生物的分布和药物的成本效益。然而，在临床环境中处理坏死性筋膜炎时，关于经验性抗生素选择的文献似乎很少。本文将概述马来西亚中部两个三级中心的常见致病微生物和当前处方趋势。方法：这是一项横断面研究，使用从马来西亚中部两家三级医院（芙蓉医院和安邦医院）收集的 NF 治疗患者的回顾性数据。从两家医院获得的五年回顾性数据中，共确定了 420 名 NF 患者。结果：处方中排名前三的经验性抗生素是氨苄西林 + 舒巴坦（本文将概述马来西亚中部两个三级中心的常见致病微生物和当前处方趋势。方法：这是一项横断面研究，使用从马来西亚中部两家三级医院（芙蓉医院和安邦医院）收集的 NF 治疗患者的回顾性数据。从两家医院获得的五年回顾性数据中，共确定了 420 名 NF 患者。结果：处方中排名前三的经验性抗生素是氨苄西林 + 舒巴坦（本文将概述马来西亚中部两个三级中心的常见致病微生物和当前处方趋势。方法：这是一项横断面研究，使用从马来西亚中部两家三级医院（芙蓉医院和安邦医院）收集的 NF 治疗患者的回顾性数据。从两家医院获得的五年回顾性数据中，共确定了 420 名 NF 患者。结果：处方中排名前三的经验性抗生素是氨苄西林 + 舒巴坦（从两家医院获得的五年回顾性数据中，共确定了 420 名 NF 患者。结果：处方中排名前三的经验性抗生素是氨苄西林 + 舒巴坦（从两家医院获得的五年回顾性数据中，共确定了 420 名 NF 患者。结果：处方中排名前三的经验性抗生素是氨苄西林 + 舒巴坦（n = 258；61.4%）、克林霉素（n = 55；13.1%）和头孢他啶（n = 41；9.8%）。抗生素的选择显着影响 NF 的结果。NF 的三大致病病原体是链球菌属。( n = 79; 18.8%)、铜绿假单胞菌( n = 61; 14.5%) 和葡萄球菌属。( n= 49; 11.7%）。接受抗生素治疗的患者被截肢的几率降低了 0.779 倍。坏死性筋膜炎实验室风险指标 (LRINEC) 评分较低的患者被截肢的几率低 0.934 倍。结论：在这项研究中，最常见的经验性抗生素处方是氨苄西林 + 舒巴坦，其次是克林霉素和头孢他啶。开出的抗生素降低了截肢的风险，因此疾病的预后更好。手术清创后使用广谱经验性抗生素可降低 NF 的死亡率。