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KMID : 0363220170550070410
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Korean Journal of Dermatology
2017 Volume.55 No. 7 p.410 ~ p.420
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A Comparative Study between Cellulitis and Necrotizing Fasciitis
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Na Ga-Hye
Park Kun
Kim Eun-Jung
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Abstract
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Background: Necrotizing fasciitis is a life-threatening soft tissue infection involving the fascia and subcutaneous tissues. Diagnosis of necrotizing fasciitis is often delayed because of an underestimation or an overlap between it and cellulitis.
Objective: We aimed to evaluate and compare the clinical, laboratory, and microbiological characteristics of cellulitis and necrotizing fasciitis.
Methods: We retrospectively reviewed medical records of patients diagnosed as having cellulitis or necrotizing fasciitis and hospitalized at our hospital between January 2011 and December 2016.
Results: The study included data from 185 patients having cellulitis and 33 patients having necrotizing fasciitis. There were significant differences between cellulitis and necrotizing fasciitis regarding clinical and laboratory factors. Necrotizing fasciitis was primarily associated with the following features at the time of admission: A thigh/buttock location [odds ratio (OR) 9.04, 95% confidence interval (CI) 1.72∼47.64, p=0.009], pain not controlled with use of non-opioid analgesics (OR 6.26, 95% CI 2.21∼17.71, p＜0.001), serum sodium level ＜135 mEq/L (OR 17.44, 95% CI 7.27∼41.84, p＜0.001), and a serum procalcitonin level ＞0.32 ng/mL (OR 9.41, 95% CI 4.18∼21.93, p ＜0.001). Additionally, polymicrobial infections and Gram-negative organisms were more commonly associated with necrotizing fasciitis compared to cellulitis.
Conclusion: We found several differences between cellulitis and necrotizing fasciitis in terms of clinical, laboratory, and microbiological characteristics. When patients showing symptoms of cellulitis present with lesions on the thigh or buttock, pain not controlled with use of non-opioid analgesics, a serum sodium level ＜135 mEq/L, or a procalcitonin level ＞0.32 ng/mL, it would be appropriate to evaluate for the possibility of necrotizing fasciitis and use broad-spectrum antibiotics to cover for Gram-negative organisms.
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KEYWORD
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Cellulitis, Necrotizing fasciitis, Pain, Procalcitonin, Sodium
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