Katie Wilcox

Katie Wilcox

Necrotizing Fasciitis Caused by Community-Associated Methicillin-Resistant

Necrotizing Fasciitis
- flesh-eating bacteria
o rapidly progressive, life-threatening infections of skin
- two types
o type 1: polymicrobial
o type 2: monomicrobial
- symptoms: fever, intense pain, and possibly redness/swelling at affected site
- treatment: debridement, antibiotics, even amputation

Staphylococcus aureus : “golden seed”
- facultatively anaerobic, gram-positive
- colonizes skin of 20% population
- Infamously antibiotic-resistant strains
o Penicillin, kanamycin, gentamicin, streptomycin, clindamycin…

Going over the paper
- 62% of community-acquired infections caused by MRSA
o Endemic proportions
- Most people had the infections on the skin and soft tissue
- Only had one reported case of MRSA associated necrotizing fasciitis

- identified all wound cultures
- reviewed case records and surgical reports
- found 14 confirmed cases out of a total of 843
- used a VITEK system took look and see what strains could be killed by antibiotics
- Molecular typing by pulsed-field gel electrophoresis (PFGE)
- Looked at the adhisin gene

The patients
- 10 males and 4 female
- Had at least 1 surgical procedure
- All survived but had serious complications
- From the hospital records it showed that 9/31 cases were caused by community wide MRSA
- Found white cells at the site of the infection

Coexisting Conditions and Risk Factors
- current or past injection drug use
- seizure disorders
- diabetes
- chronic hepatitis C
- no co-existing conditions or risk factors
- homeless
- hospitalized in previous year
- some had history of MRSA infection
- exposure to beta-lactam antibiotics in previous 6 months
- preoperative diagnosis: 57% abscess, 36% necrotizing fasciitis, 7% mediastinitis

Microbiologic Data
- 4 patients with monomicrobial infections had negative anaerobic wound culture
- 9 patients with monomicrobial infections with gram positive

Molecular/Genetic Data
- only five patients available for genetic analysis

- community associated MRSA increasingly endemic
- common factors
o 57% preoperative diagnosis skin or soft-tissue abscess
o Surprisingly high survival rate
 Serious complications were common
- MRSA is capable of causing rapidly progressive NF

“Treat empirically”  do what, uh, is usually done in this kind of situation. Don’t take risks!

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License