Host Factors
Type 3 NSTIs caused by E. coli are typically seen in
immunocompromised patients, such as those with liver cirrhosis, chronic
kidney disease and haematologic malignancy (4). For such patients, the
potential for a more severe condition to develop is higher and the
mortality rate is higher. This degree of increased risk was shown in a
report that summarised 18 cases of NSTIs caused by E. coli since
1994, in which 13 (73%) of the patients died (4).
The patient in this case had alcoholic liver cirrhosis (Child-Pugh C).
It is well known that patients with liver cirrhosis are compromised
immunologically, a state that often leads to bacteraemia and sepsis by
the intestinal-portal route and that results in a high rate of morbidity
and mortality (7,8). The main reasons for these outcomes in this patient
population are intestinal bacterial overgrowth, bacterial translocation
caused by disruption of enteric barrier and dysfunction of hepatic and
systemic immune system (8). These factors result in an increase of the
risk of bacteraemia and sepsis in patients with cirrhosis.