Mrsa necrotizing Fasciitis in a Neonate Mei-Lin T. Pang md, Carla T. Lee Md

MRSA Necrotizing Fasciitis in a Neonate

• Mei-Lin T. Pang MD, Carla T. Lee MD,

• Brandie J. Metz MD, Sheila F. Friedlander MD,

• Victoria R. Barrio MD, Lawrence F. Eichenfield MD

• Children’s Hospital San Diego

• July 8, 2006

History of Present Illness

• 5 d.o. male -- T 101º F & “fussiness”

• FT NSVD; abdominal pustule --DOL3, spontaneously resolved

• ER evaluation: Irritable, no focal findings

• Sepsis w/u: unsuccessful LP
• Noted on admission:
• 2 cm poorly defined subtle induration and erythema noted at site of lumbar puncture

History of Present Illness

• Hospital course: hypoxia, hypotension

•  intubation, pressors, PICU

• Pediatric dermatology consult re: progressive induration and erythema of the lumbar puncture site

Necrotizing fasciitis (NF)

• Potentially fatal bacterial infection of soft tissue

• --rapidly progressive tissue edema, inflammation, and sytemic toxicity

• Prompt surgical debridement mandatory

Neonatal Necrotizing Fasciitis:

• Less than 70 cases in the literature

• 2 series: Taiwan and Pakistan (12 patients)

• Commonly truncal; abdominal wall most common

• Mortality close to 50%

• Associations:

• --omphalitis
• --balanitis
• --mastitis
• --postoperative complications
• --fetal monitoring

Neonatal NF

• Usually polymicrobial

• staph predominant organism
• Rare cases of MRSA

• 60% increase in MRSA - U.S. Hospitals

• Rx: Vancomycin for all cases of necrotizing fasciitis in communities with high rates of MRSA

References

• Hsieh W, Yang P, Chao H, et al. Neonatal necrotizing fasciitis: A report of three cases and review of the literature. Pediatrics. [serial online]. April 1999;103:e53. Available at: http://www.pediatrics.org/cgi/content/103/4/e53.

• Nazir Z. Necrotizing fasciitis in neonates. Pediatr Surg Int. 2005;21:641-644.

• Purcell K, Fergie J. Epidemic of community-acquired methicillin resistant Staphylococcus aureus infections. Arch Pediatr Adolesc Med. 2005;159:980-985.