The epidemiology of necrotizing fasciitis including factors associated with death and amputation
ABSTRACT The high morbidity and mortality of necrotizing fasciitis (NF) supports the need for epidemiological studies to characterize the disease and identify patient factors associated with adverse outcomes. A multi-site medical record review of patients diagnosed with NF was performed (n=80, mortality 15%). Variables collected were hypothesized to have association with adverse outcomes from NF, and multivariable analysis was used to detect any such association in this population. Select factors associated with mortality included evidence of underlying conditions (P=0.002), advanced age (P=0.04), young age (P=0.03), and evidence of sepsis (P=0.006). Select factors associated with amputation included diabetes mellitus (P=0.006), evidence of underlying conditions (P=0.03), and cutaneous gangrene noted on admission (P=0.006). These findings demonstrate the important association of NF and extremes of age with mortality and morbidity and support the value of early suspicion with prompt diagnosis and treatment in order to prevent adverse outcomes since the associated risk factors are not immediately modifiable.
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ABSTRACT: Flux analysis (FA) is a means of organizing data to show flux through the central metabolic pathways (CMPs). It quantifies flux from uptake of carbon to the outputs of the CMPs, which are the precursors used for biosynthesis, acetate excretion and CO2. Fluxes to precursors reflect the commands of the genome and acetate excretion balances fluxes to precursor supply when uptake exceeds the capacity of the CMPs to allocate carbon in exactly the correct amount to each precursor. No other products have been detected in 11 phenotypes of Escherichia coli ML308. FA of each of these 11 phenotypes (with some additional variations in culture conditions, some selected mutations and one genetic construct) are shown as flux (mol (kg dry weight biomass)-1 h-1) and are the starting point for further exploration of the physiology of E. coli: FAs suggest the possibility of four strategies to reduce acetate excretion and these have been tested in two of the phenotypes (glucose and pyruvate). All are successful to some degree but results are not always what were expected. FA of such interventions suggest that some 'global' control mechanisms operate in E. coli ML308 independent of carbon source. There is a division in the CMPs between those pathways that use phosphorylated intermediates and those that do not and these, in turn, are divided into the Krebs cycle and the C2 and C3 monocarboxylic acids. Altogether, there are four 'compartments' and each contains intermediates that are also precursors.Advances in Microbial Physiology 02/2001; 45:271-340. DOI:10.1016/S0065-2911(01)45006-5
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ABSTRACT: Invasive group A streptococcus (iGAS) is the most common cause of monomicrobial necrotising fasciitis. Necrotising infections of the extremities may present directly to orthopaedic surgeons or by reference from another admitting specialty. Recent epidemiological data from the Health Protection Agency suggest an increasing incidence of iGAS infection in England. Almost 40% of those affected had no predisposing illnesses or risk factors, and the proportion of children presenting with infections has risen. These observations have prompted the Chief Medical Officer for the Central Alerting System in England to write to general practitioners and hospitals, highlighting the need for clinical vigilance, early diagnosis and rapid initiation of treatment in suspected cases. The purpose of this annotation is to summarise the recent epidemiological trends, describe the presenting features and outline the current investigations and treatment of this rare but life-threatening condition.The Bone & Joint Journal 06/2010; 92(6):763-9. DOI:10.1302/0301-620X.92B6.23447
- ANZ Journal of Surgery 12/2010; 80(12):948-9. DOI:10.1111/j.1445-2197.2010.05562.x