Monomicrobial necrotizing fasciitis in a single center: The emergence of Gram-negative bacteria as a common pathogen

D. Yahav, H. Duskin-Bitan, N. Eliakim-Raz, H. Ben-Zvi, H. Shaked, E. Goldberg, J. Bishara

Research output: Contribution to journalArticlepeer-review


Background: Necrotizing fasciitis (NF) is a life-threatening soft tissue infection. It is usually caused by Streptococcus pyogenes and other Gram-positive bacteria. Several reports, however, emphasize the importance of Gram-negative rods in this infection. Methods: We retrospectively studied all cases of monomicrobial necrotizing fasciitis hospitalized in our center during the years 2002-2012. We compared clinical characteristics and outcomes of patients with Gram-negative versus Gram-positive infection. Results: Forty-five cases were reviewed, 19 caused by Gram-negative organisms, 10 of them Escherichia coli, and 26 caused by Gram-positive organisms, 10 of them S. pyogenes. Compared to Gram-positive infections, patients with Gram-negative infections were more likely to have a baseline malignancy (9/19, 47.4%) or to have undergone recent surgery (4/19, 42.3%). The 30-day mortality was higher among Gram-negative infected patients (8/19, 42.1% vs. 8/26, 30.8%). Creatine phosphokinase (CPK) was elevated in a minority of patients with Gram-negative necrotizing fasciitis, and its absolute value was lower than in Gram-positive necrotizing fasciitis. Conclusions: In our center, 42% of monomicrobial necrotizing fasciitis cases were found to be caused by Gram-negative organisms, mostly E. coli. These infections usually appeared in immunocompromised or postoperative patients, often presented with normal CPK levels, and were associated with high mortality rates.

Original languageEnglish
Pages (from-to)13-16
Number of pages4
JournalInternational Journal of Infectious Diseases
StatePublished - 1 Nov 2014


  • Creatine phosphokinase
  • Escherichia coli
  • Gram-negative
  • Necrotizing fasciitis
  • Soft tissue infection


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