{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T15:21:03Z","timestamp":1791818463867,"version":"4.3.4"},"reference-count":26,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T00:00:00Z","timestamp":1631836800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/antibiotics10091120","type":"journal-article","created":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T21:23:29Z","timestamp":1631913809000},"page":"1120","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Local Trends of Antibiotic Prescriptions for Necrotizing Fasciitis Patients in Two Tertiary Care Hospitals in Central Malaysia"],"prefix":"10.3390","volume":"10","author":[{"given":"Sanjiv","family":"Rampal","sequence":"first","affiliation":[{"name":"Department of Orthopaedic and Traumatology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanusha","family":"Ganesan","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narresh","family":"Sisubalasingam","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Traumatology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasantha Kumari","family":"Neela","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Traumatology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Ali","family":"Tokg\u00f6z","sequence":"additional","affiliation":[{"name":"Kecioren Education and Training Hospital, P\u0131narba\u015f\u0131 Quarter Sanatoryum Street Ke\u00e7i\u00f6ren, Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun","family":"Arunasalam","sequence":"additional","affiliation":[{"name":"Urology Department, Hospital Serdang, Ministry of Health of Malaysia, Putrajaya 62590, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohd Asyraf Hafizuddin","family":"Ab Halim","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Traumatology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan 43400, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zulfahrizzat Bin","family":"Shamsudin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital Tuanku Ja\u2019afar Seremban, Seremban 70300, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0505-7554","authenticated-orcid":false,"given":"Suresh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Centre for Materials Engineering and Regenerative Medicine, Bharath Institute of Higher Education and Research, Chennai 600173, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7572-9926","authenticated-orcid":false,"given":"Ajantha","family":"Sinniah","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1089\/sur.2015.238","article-title":"A Multi-Center Review of Care Patterns and Outcomes in Necrotizing Soft Tissue Infections","volume":"17","author":"Faraklas","year":"2016","journal-title":"Surg. Infect."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1093\/cid\/ciw248","article-title":"Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005\u20132012","volume":"63","author":"Nelson","year":"2016","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1097\/BCR.0b013e3181b48321","article-title":"Necrotizing soft-tissue infections: Clinical guidelines","volume":"30","author":"Endorf","year":"2009","journal-title":"J. Burn. Care Res. Off. Publ. Am. Burn. Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.1016\/j.injury.2007.10.030","article-title":"Necrotising fasciitis of upper and lower limb: A systematic review","volume":"38","author":"Angoules","year":"2007","journal-title":"Injury"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1086\/521264","article-title":"The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000\u20132004","volume":"45","author":"Roberson","year":"2007","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e119","DOI":"10.1002\/bjs.9371","article-title":"Early diagnosis of necrotizing fasciitis","volume":"101","author":"Goh","year":"2014","journal-title":"Br. J. Surg."},{"key":"ref_7","first-page":"467","article-title":"Independent predictors of mortality for necrotizing fasciitis: A retrospective analysis in a single institution","volume":"71","author":"Huang","year":"2011","journal-title":"J. Trauma"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1959","DOI":"10.2147\/IDR.S172366","article-title":"Management of complicated skin and soft tissue infections with a special focus on the role of newer antibiotics","volume":"11","author":"Leong","year":"2018","journal-title":"Infect. Drug Resist."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s13049-017-0359-z","article-title":"The laboratory risk indicator for necrotizing fasciitis (LRINEC) scoring: The diagnostic and potential prognostic role","volume":"25","author":"Asim","year":"2017","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.idc.2017.05.011","article-title":"Evaluation and Management of Necrotizing Soft Tissue Infections","volume":"31","author":"Bonne","year":"2017","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"174","DOI":"10.5435\/00124635-200903000-00006","article-title":"Necrotizing Fasciitis","volume":"17","author":"Bellapianta","year":"2009","journal-title":"JAAOS J. Am. Acad. Orthop. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1097\/01.CCM.0000129486.35458.7D","article-title":"The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: A tool for distinguishing necrotizing fasciitis from other soft tissue infections","volume":"32","author":"Wong","year":"2004","journal-title":"Crit. Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1308\/rcsann.2017.0053","article-title":"Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: A systematic review of the literature","volume":"99","author":"Bechar","year":"2017","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"36","DOI":"10.3389\/fsurg.2014.00036","article-title":"Current concepts in the management of necrotizing fasciitis","volume":"1","author":"Misiakos","year":"2014","journal-title":"Front. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Stanaszek-Tomal, E. (2020). Environmental Factors Causing the Development of Microorganisms on the Surfaces of National Cultural Monuments Made of Mineral Building Materials\u2014Review. Coatings, 10.","DOI":"10.3390\/coatings10121203"},{"key":"ref_16","unstructured":"(2021, July 20). FDA, Unasyn, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2008\/050608s029lbl.pdf."},{"key":"ref_17","unstructured":"(2021, July 20). FDA, Cleoncin Hcl, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2014\/050162s092s093lbl.pdf."},{"key":"ref_18","unstructured":"(2021, July 20). FDA, Fortaz, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2020\/050578s062lbl.pdf."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1093\/cid\/ciu296","article-title":"Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_20","first-page":"S39","article-title":"Consensus document on controversial issues in the treatment of complicated skin and skin-structure infections","volume":"14","author":"Pan","year":"2010","journal-title":"Int. J. Infect. Dis. IJID Off. Publ. Int. Soc. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S66","DOI":"10.1016\/S0020-1383(16)30609-X","article-title":"Necrotising fasciitis of the extremities: Implementation of new management technologies","volume":"47","author":"Corona","year":"2016","journal-title":"Injury"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2919","DOI":"10.1007\/s00268-020-05581-4","article-title":"Necrotizing Fasciitis: A Predictable Burden in Rural Kenya","volume":"44","author":"Lunar","year":"2020","journal-title":"World J. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1093\/cid\/cir034","article-title":"Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: Executive summary","volume":"52","author":"Liu","year":"2011","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s00068-017-0792-8","article-title":"Necrotizing fasciitis: Treatment concepts and clinical results","volume":"44","author":"Leiblein","year":"2018","journal-title":"Eur. J. Trauma Emerg. Surg. Off. Publ. Eur. Trauma Soc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/BF00314855","article-title":"A comparison of the effect of lisinopril and hydrochlorothiazide on electrolyte balance in essential hypertension","volume":"42","author":"Frewin","year":"1992","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1016\/S0009-9236(01)74143-4","article-title":"Angioplasty increases target site concentrations of ciprofloxacin in patients with peripheral arterial occlusive disease","volume":"70","author":"Joukhadar","year":"2001","journal-title":"Clin. Pharmacol. Ther."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/9\/1120\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:01:03Z","timestamp":1760166063000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/9\/1120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,17]]},"references-count":26,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["antibiotics10091120"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics10091120","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,17]]}}}