Necrotizing Fasciitis Caused by Aeromonas Species-A Case Series in a Single Institution

Background: Aeromonas species are Gram-negative bacilli that thrive in aquatic environments, including sewage, fresh or brackish water, soil, tap water, and nonfecal organic materials. Necrotizing fasciitis (NF) caused by Aeromonas species is less common than NF due to other bacterial species; however, it is associated with higher morbidity and mortality rates. Furthermore, it is difficult to differentiate between NF caused by Aeromonas species and NF due to other types of bacteria based on clinical symptoms alone. Aims and Objectives: The purpose of the study is to present our clinical experience treating patients with this disease at a single institution and to differentiate clinical presentation between NF caused by Aeromonas species and NF due to other types of bacteria. Material and Methods: In this retrospective study, we enrolled all patients (n = 472) with a diagnosis of NF who had been treated at a single medical center during a seven-year period. Data on patient characteristics, affected sites, clinical symptoms, results of microbiological tests, antibiotic therapy, surgical intervention, and outcomes were obtained from the medical records and were compared between the group of patients with Aeromonas NF and the group of patients with non-Aeromonas NF. Results: During the study period, 21 patients had necrotizing fasciitis due to Aeromonas species and 451 had NF due to other types of bacteria. The overall mortality rate among patients with Aerononas infection was 38.1% (n = 8). Shock at admission, and prolonged activated partial thromboplastin time were significantly associated with Aeromonas infections in the univariate analysis. Conclusions: Based on our findings, Aeromonas infection may be considered in patients with ahistory of exposure to soil, fresh water, or brackish water who present with a fulminant clinical course accompanied by shock and prolonged aPTT. Early diagnosis, prompt surgical intervention, and administration of appropriate antibiotic therapy comprising a third-generation cephalosporin combined with doxycycline or minocycline can help improve survival and minimize morbidity in patients with necrotizing fasciitis caused by Aeromonas species.