ArticleBMC infectious diseases2026
Assessing the impact of bacteremia and antibiotic resistance on mortality in patients with monomicrobial and polymicrobial Escherichia coli necrotizing fasciitis.
Article in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMonomicrobial necrotizing fasciitis (NF) caused by Escherichia coli (E. coli), is exceptionally uncommon and has been reported to be associated with death. The purposes of this study were to elucidate the specific characteristics of E. coli NF, to compare the independent predictors related to surgical outcomes between the monomicrobial and polymicrobial groups, and to investigate antibiotics usage and resistance.
methodsTwenty-five NF patients who revealed monomicrobial E. coli infection and polymicrobial NF with only E. coli growing heavy and predominant in wound and blood cultures were retrospectively reviewed over a 16-year period. Differences in in-hospital mortality, clinical outcomes, laboratory findings, presentation of bacteremia, antibiotics resistance and presentation of hemorrhagic bullae were compared between the monomicrobial and polymicrobial NF groups.
resultsFour of 10 patients (40%) with monomicrobial infections and one of 15 patients (6.7%) with polymicrobial infections died. The patients in the monomicrobial group had a significantly higher incidence of bacteremia, shock, lower total white blood cell (WBC) counts, higher banded forms, higher lactate, higher creatinine and lower platelet counts than those in the polymicrobial group. No significant difference was observed for escalation of antibiotics among the death and the survival patients while ineffective empirical antimicrobial using at initial admission.
conclusionMonomicrobial NF caused by E. coli was rare and revealed more fulminating and higher mortality than polymicrobial NF. We confirmed that those factors including shock, bacteremia, lower WBC counts, higher banded leukocyte counts, lower segmented leukocyte counts, higher lactate levels, and lower albumin levels were associated mortality in E. coli NF. Fourteen patients (56%) confirmed antibiotics resistant E. coli stains, and 9 patients were found ineffective empirical antimicrobial usage, and thus early application of effective antimicrobial agents with escalation therapy may improve the outcomes of E. coli NF patients after emergent surgery.
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