{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T19:55:09Z","timestamp":1790452509465,"version":"4.1.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,8,9]],"date-time":"2021-08-09T00:00:00Z","timestamp":1628467200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,9]],"date-time":"2021-08-09T00:00:00Z","timestamp":1628467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p><jats:italic>Vibrio vulnificus<\/jats:italic> has been reported as the leading causative pathogen of necrotizing fasciitis (NF) and related fatality in the coastal area. Necrotizing fasciitis caused by methicillin-resistant <jats:italic>Staphylococcus aureus<\/jats:italic> (MRSA) and <jats:italic>V. vulnificus<\/jats:italic> have high mortality rates. The purpose of this prospective study was to clarify the clinical characteristics between death and survival NF patients, to investigate bacteriologic profile and mortality of NF patients, and to compare risk indicators of MRSA and <jats:italic>V. vulnificus<\/jats:italic> NF patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This prospective study was conducted in 184 consecutive NF patients over a period of three years in a tertiary coastal hospital. Differences in mortality, laboratory findings, microbiology and clinical outcomes were compared between the death and survival groups, and the <jats:italic>V. vulnificus<\/jats:italic> and MRSA subgroups.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Twenty patients died, resulting in a mortality rate of 10.9%, and there were 108 patients with a monomicrobial infection (58.7%). The death group had a significantly higher incidence of shock at emergency room and bacteremia than did the survival group. <jats:italic>Vibrio<\/jats:italic> species (40 cases) and <jats:italic>S. aureus<\/jats:italic> (31 cases) were the two major pathogens. Significant differences with respect to hepatic dysfunction, shock, the event with seawater or seafood contact, bacteremia, C-reactive protein, mean platelet counts, and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score were observes between <jats:italic>V. vulnificus<\/jats:italic> and MRSA groups.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>NF patients with both hepatic dysfunction and diabetes mellitus, bacteremia and shock have significantly higher mortality. We should be aware of the increasing incidence of monomicrobial NF and higher mortality rates of Gram-negative pathogens in the warm coastal area. LRINEC score is not a suitable diagnostic indicator for <jats:italic>V. vulnificus<\/jats:italic> NF, which is more rapidly progressive and fulminant than MRSA NF. NF needed team works by early suspicion, immediate surgical intervention and aggressive care, which can successfully decrease mortality.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-021-06518-5","type":"journal-article","created":{"date-parts":[[2021,8,9]],"date-time":"2021-08-09T06:02:50Z","timestamp":1628488970000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Bacteriology and mortality of necrotizing fasciitis in a tertiary coastal hospital with comparing risk indicators of methicillin-resistant Staphylococcus aureus and Vibrio vulnificus infections: a prospective study"],"prefix":"10.1186","volume":"21","author":[{"given":"Yao-Hung","family":"Tsai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsung-Yu","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiun-Liang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Ting","family":"Hsiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang-Tseng","family":"Kuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo-Chin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,9]]},"reference":[{"key":"6518_CR1","doi-asserted-by":"publisher","first-page":"1454","DOI":"10.2106\/00004623-200308000-00005","volume":"85-A","author":"CH Wong","year":"2003","unstructured":"Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Jt Surg Am. 2003;85-A:1454\u201360.","journal-title":"J Bone Jt Surg Am"},{"key":"6518_CR2","doi-asserted-by":"publisher","first-page":"151","DOI":"10.5435\/00124635-200005000-00002","volume":"8","author":"RA Fontes Jr","year":"2000","unstructured":"Fontes RA Jr, Ogilvie CM, Miclau T. Necrotizing soft-tissue infections. J Am Acad Orthop Surg. 2000;8:151\u20138.","journal-title":"J Am Acad Orthop Surg"},{"key":"6518_CR3","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/S0002-9610(00)00360-3","volume":"179","author":"D Elliott","year":"2000","unstructured":"Elliott D, Kufera JA, Myers RA. The microbiology of necrotizing soft tissue infections. Am J Surg. 2000;179:361\u20136.","journal-title":"Am J Surg"},{"key":"6518_CR4","first-page":"195","volume":"8","author":"P Khamnuan","year":"2015","unstructured":"Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Tantraworasin A. Necrotizing fasciitis: epidemiology and clinical predictors for amputation. Int J Gen Med. 2015;8:195\u2013202.","journal-title":"Int J Gen Med"},{"key":"6518_CR5","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/j.jhin.2010.01.028","volume":"75","author":"MS Morgan","year":"2010","unstructured":"Morgan MS. Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect. 2010;75:249\u201357.","journal-title":"J Hosp Infect"},{"key":"6518_CR6","doi-asserted-by":"publisher","first-page":"2230","DOI":"10.1007\/s11999-010-1311-y","volume":"468","author":"YH Tsai","year":"2010","unstructured":"Tsai YH, Hsu RW, Huang KC, Huang TJ. Laboratory indicators for early detection and surgical treatment of Vibrio necrotizing fasciitis. Clin Orthop Relat Res. 2010;468:2230\u20137.","journal-title":"Clin Orthop Relat Res"},{"key":"6518_CR7","doi-asserted-by":"publisher","first-page":"36","DOI":"10.3389\/fsurg.2014.00036","volume":"1","author":"EP Misiakos","year":"2014","unstructured":"Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Front Surg. 2014;1:36.","journal-title":"Front Surg"},{"key":"6518_CR8","doi-asserted-by":"publisher","first-page":"1899","DOI":"10.1007\/s00134-016-4576-0","volume":"42","author":"JP Burnham","year":"2016","unstructured":"Burnham JP, Kirby JP, Kollef MH. Diagnosis and management of skin and soft tissue infections in the intensive care unit: a review. Intensive Care Med. 2016;42:1899\u2013911.","journal-title":"Intensive Care Med"},{"key":"6518_CR9","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1016\/j.surge.2014.01.005","volume":"13","author":"C Waldron","year":"2015","unstructured":"Waldron C, Solon JG, O\u2019Gorman J, Humphreys H, Burke JP, McNamara DA. Necrotizing fasciitis: the need for urgent surgical intervention and the impact of intravenous drug use. Surgeon. 2015;13:194\u20139.","journal-title":"Surgeon"},{"key":"6518_CR10","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1186\/s12879-015-1144-0","volume":"15","author":"NC Cheng","year":"2015","unstructured":"Cheng NC, Tai HC, Chang SC, Chang CH, Lai HS. Necrotizing fasciitis in patients with diabetes mellitus: clinical characteristics and risk factors for mortality. BMC Infect Dis. 2015;15:417.","journal-title":"BMC Infect Dis"},{"issue":"6","key":"6518_CR11","doi-asserted-by":"publisher","first-page":"1338","DOI":"10.1017\/S0950268815002745","volume":"144","author":"N Arif","year":"2016","unstructured":"Arif N, Yousfi S, Vinnard C. Deaths from necrotizing fasciitis in the United States, 2003\u20132013. Epidemiol Infect. 2016;144(6):1338\u201344.","journal-title":"Epidemiol Infect"},{"key":"6518_CR12","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.bjid.2013.08.003","volume":"18","author":"JM Wang","year":"2014","unstructured":"Wang JM, Lim HK. Necrotizing fasciitis: eight-year experience and literature review. Braz J Infect Dis. 2014;18:137\u201343.","journal-title":"Braz J Infect Dis"},{"key":"6518_CR13","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1016\/j.amjsurg.2007.08.047","volume":"194","author":"TC Lee","year":"2007","unstructured":"Lee TC, Carrick MM, Scott BG, Hodges JC, Pham HQ. Incidence and clinical characteristics of methicillin-resistant Staphylococcus aureus necrotizing fasciitis in a large urban hospital. Am J Surg. 2007;194:809\u201312.","journal-title":"Am J Surg"},{"key":"6518_CR14","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1186\/1471-2334-11-297","volume":"11","author":"CH Changchien","year":"2011","unstructured":"Changchien CH, Chen YY, Chen SW, Chen WL, Tsay JG, Chu C. Retrospective study of necrotizing fasciitis and characterization of its associated methicillin-resistant Staphylococcus aureus in Taiwan. BMC Infect Dis. 2011;11:297.","journal-title":"BMC Infect Dis"},{"key":"6518_CR15","doi-asserted-by":"publisher","first-page":"274","DOI":"10.2106\/JBJS.I.01679","volume":"93","author":"YH Tsai","year":"2011","unstructured":"Tsai YH, Wen-Wei Hsu R, Huang KC, Huang TJ. Comparison of necrotizing fasciitis and sepsis caused by Vibrio vulnificus and Staphylococcus aureus. J Bone Jt Surg Am. 2011;93:274\u201384.","journal-title":"J Bone Jt Surg Am"},{"key":"6518_CR16","doi-asserted-by":"publisher","first-page":"136","DOI":"10.4103\/2319-4170.137767","volume":"38","author":"JC Hsu","year":"2015","unstructured":"Hsu JC, Shen SH, Yang TY, Chen PH, Huang KC, Tsai YH. Necrotizing fasciitis and sepsis caused by Vibrio vulnificus and Klebsiella pneumoniae in diabetic patients. Biomed J. 2015;38:136\u201342.","journal-title":"Biomed J"},{"key":"6518_CR17","doi-asserted-by":"publisher","first-page":"2497","DOI":"10.2106\/00004623-200411000-00021","volume":"86-A","author":"YH Tsai","year":"2004","unstructured":"Tsai YH, Hsu RW, Huang KC, Chen CH, Cheng CC, Peng KT, et al. Systemic Vibrio infection presenting as necrotizing fasciitis and sepsis. A series of thirteen cases. J Bone Jt Surg Am. 2004;86-A:2497\u2013502.","journal-title":"J Bone Jt Surg Am"},{"key":"6518_CR18","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1007\/s10096-013-2039-x","volume":"33","author":"YC Lee","year":"2014","unstructured":"Lee YC, Hor LI, Chiu HY, Lee JW, Shieh SJ. Prognostic factor of mortality and its clinical implications in patients with necrotizing fasciitis caused by Vibrio vulnificus. Eur J Clin Microbiol Infect Dis. 2014;33:1011\u20138.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"6518_CR19","doi-asserted-by":"publisher","first-page":"e159","DOI":"10.1016\/j.ijid.2011.11.001","volume":"16","author":"YH Tsai","year":"2012","unstructured":"Tsai YH, Huang KC, Shen SH, Hsu WH, Peng KT, Huang TJ. Microbiology and surgical indicators of necrotizing fasciitis in a tertiary hospital of southwest Taiwan. Int J Infect Dis. 2012;16:e159\u201365.","journal-title":"Int J Infect Dis"},{"key":"6518_CR20","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/j.ajem.2007.04.023","volume":"26","author":"CT Hsiao","year":"2008","unstructured":"Hsiao CT, Weng HH, Yuan YD, Chen CT, Chen IC. Predictors of mortality in patients with necrotizing fasciitis. Am J Emerg Med. 2008;26:170\u20135.","journal-title":"Am J Emerg Med"},{"key":"6518_CR21","doi-asserted-by":"publisher","first-page":"435","DOI":"10.3390\/jcm7110435","volume":"7","author":"CP Chang","year":"2018","unstructured":"Chang CP, Fann WC, Wu SR, Lin CN, Chen IC, Hsiao CT. Diagnostic performance of initial serum albumin level for predicting in-hospital mortality among necrotizing fasciitis patients. J Clin Med. 2018;7:435.","journal-title":"J Clin Med"},{"issue":"4","key":"6518_CR22","doi-asserted-by":"publisher","first-page":"e510","DOI":"10.3928\/01477447-20120327-43","volume":"35","author":"D Scher","year":"2012","unstructured":"Scher D, Kanlic E, Bader J, Ortiz M, Abdelgawad A. Hepatitis C viral infection as an associated risk factor for necrotizing fasciitis. Orthopedics. 2012;35(4):e510\u20133.","journal-title":"Orthopedics"},{"key":"6518_CR23","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/j.jmii.2012.08.019","volume":"47","author":"CJ Wu","year":"2014","unstructured":"Wu CJ, Chen PL, Tang HJ, et al. Incidence of Aeromonas bacteremia in southern Taiwan: Vibrio and Salmonella bacteremia as comparators. J Microbiol Immunol Infect. 2014;47:145\u20138.","journal-title":"J Microbiol Immunol Infect"},{"issue":"10","key":"6518_CR24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0223513","volume":"14","author":"PY Chuang","year":"2019","unstructured":"Chuang PY, Yang TY, Huang TW, Tsai YH, Huang KC, Weng HH. Hepatic disease and the risk of mortality of Vibrio vulnificus necrotizing skin and soft tissue infections: a systematic review and meta-analysis. PLoS ONE. 2019;14(10): e0223513.","journal-title":"PLoS ONE"},{"key":"6518_CR25","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.diagmicrobio.2018.12.013","volume":"94","author":"SY Park","year":"2019","unstructured":"Park SY, Yu SN, Lee EJ, Kim T, Jeon MH, Choo EJ, Park S, et al. Monomicrobial gram-negative necrotizing fasciitis: an uncommon but fatal syndrome. Diagn Microbiol Infect Dis. 2019;94:183\u20137.","journal-title":"Diagn Microbiol Infect Dis"},{"key":"6518_CR26","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s12879-020-4796-3","volume":"20","author":"TU Huang","year":"2020","unstructured":"Huang TU, Peng KT, Hsiao CT, Fann WC, Tsai YH, Li YY, et al. Predictors for gram-negative monomicrobial necrotizing fasciitis in southern Taiwan. BMC Infect Dis. 2020;20:60.","journal-title":"BMC Infect Dis"},{"key":"6518_CR27","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.ijid.2014.05.024","volume":"28","author":"D Yahav","year":"2014","unstructured":"Yahav D, Duskin-Bitan H, Eliakim-Raz N, Ben-Zvi H, Shaked H, Goldberg E, et al. Monomicrobial necrotizing fasciitis in a single center: the emergence of Gram-negative bacteria as a common pathogen. Int J Infect Dis. 2014;28:13\u20136.","journal-title":"Int J Infect Dis"},{"issue":"4","key":"6518_CR28","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/j.jmii.2014.05.006","volume":"49","author":"LS Syue","year":"2016","unstructured":"Syue LS, Chen PL, Wu CJ, Lee NY, Lee CC, Li CW, et al. Monomicrobial Aeromonas and Vibrio bacteremia in cirrhotic adults in southern Taiwan-similarities and differences. J Microbiol Immunol Infect. 2016;49(4):509\u201315.","journal-title":"J Microbiol Immunol Infect"},{"key":"6518_CR29","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/1471-2334-11-5","volume":"11","author":"CY Lee","year":"2011","unstructured":"Lee CY, Kuo LT, Peng KT, Hsu WH, Huang TW, Chou YC. Prognostic factors and monomicrobial necrotizing fasciitis: gram-positive versus gram-negative pathogens. BMC Infect Dis. 2011;11:5.","journal-title":"BMC Infect Dis"},{"issue":"2","key":"6518_CR30","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1007\/s11739-018-1973-0","volume":"14","author":"CP Chang","year":"2019","unstructured":"Chang CP, Hsiao CT, Fann WC. Risk factors associated with bacteremia correlated with mortality in patients with acute bacterial skin and skin structure infection. Intern Emerg Med. 2019;14(2):259\u201364.","journal-title":"Intern Emerg Med"},{"key":"6518_CR31","doi-asserted-by":"publisher","first-page":"7716","DOI":"10.1038\/s41598-020-64741-7","volume":"10","author":"TY Huang","year":"2020","unstructured":"Huang TY, Peng KT, Hsu WH, Hung CH, Chuang FY, Tsai YH. Independent predictors of mortality for aeromonas necrotizing fasciitis of limbs: an 18-year retrospective study. Sci Rep. 2020;10:7716.","journal-title":"Sci Rep"},{"issue":"1","key":"6518_CR32","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0227748","volume":"15","author":"CT Hsiao","year":"2020","unstructured":"Hsiao CT, Chang CP, Huang TY, Chen YC, Fann WC. Prospective validation of the laboratory risk indicator for necrotizing fasciitis (LRINEC) score for necrotizing fasciitis of the extremities. PLoS ONE. 2020;15(1): e0227748.","journal-title":"PLoS ONE"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06518-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-021-06518-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06518-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,9]],"date-time":"2021-08-09T06:03:21Z","timestamp":1628489001000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-021-06518-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,9]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["6518"],"URL":"https:\/\/doi.org\/10.1186\/s12879-021-06518-5","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,9]]},"assertion":[{"value":"26 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 August 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was approved by the Institutional Review Board of Chang Gung Medical Foundation (103-2081B). Written informed consent was obtained from all individual patients included in the study for a possible future use of the samples that could be given as an extension of the original research. Informed consent was obtained from all subjects included in this study, and all methods were carried out in accordance with relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for patient information to be published was provided by each patient.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None of the authors reports a potential conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"771"}}