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Previous Volume 352:1445-1453 April 7, 2005 Number 14 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Chambers, H. F. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Necrotizing fasciitis is a life-threatening infection requiring urgent surgical and medical therapy. Staphylococcus aureus has been a very uncommon cause of necrotizing fasciitis, but we have recently noted an alarming number of these infections caused by community-associated methicillin-resistant S. aureus (MRSA).

Methods We reviewed the records of 843 patients whose wound cultures grew MRSA at our center from January 15, 2003, to April 15, 2004. Among this cohort, 14 were identified as patients presenting from the community with clinical and intraoperative findings of necrotizing fasciitis, necrotizing myositis, or both.

Results The median age of the patients was 46 years (range, 28 to 68), and 71 percent were men. Coexisting conditions or risk factors included current or past injection-drug use (43 percent); previous MRSA infection, diabetes, and chronic hepatitis C (21 percent each); and cancer and human immunodeficiency virus infection or the acquired immunodeficiency syndrome (7 percent each). Four patients (29 percent) had no serious coexisting conditions or risk factors. All patients received combined medical and surgical therapy, and none died, but they had serious complications, including the need for reconstructive surgery and prolonged stay in the intensive care unit. Wound cultures were monomicrobial for MRSA in 86 percent, and 40 percent of patients (4 of 10) for whom blood cultures were obtained had positive results. All MRSA isolates were susceptible in vitro to clindamycin, trimethoprim–sulfamethoxazole, and rifampin. All recovered isolates belonged to the same genotype (multilocus sequence type ST8, pulsed-field type USA300, and staphylococcal cassette chromosome mec type IV [SCCmecIV]) and carried the Panton–Valentine leukocidin (pvl), lukD, and lukE genes, but no other toxin genes were detected.

Conclusions Necrotizing fasciitis caused by community-associated MRSA is an emerging clinical entity. In areas in which community-associated MRSA infection is endemic, empirical treatment of suspected necrotizing fasciitis should include antibiotics predictably active against this pathogen.

Source Information

From the Divisions of Infectious Diseases and HIV Medicine (L.G.M., G.R., A.S.B., B.S.) and the Department of Internal Medicine (L.G.M., G.R., J.P., A.S.B., B.S.), Harbor–UCLA Medical Center and the Los Angeles Biomedical Institute at Harbor–UCLA, Torrance; the University of California, San Francisco (F.P.-R.); and St. Mary Medical Center, Long Beach (S.M., A.W.T., T.O.P.) — all in California.

Full Text of this Article

Related Letters:

MRSA in the Community
Chapman A. L.N., Greig J. M., Innes J. A., Hageman J. C., Lynfield R., Fridkin S. K., Miller L. G., Perdreau-Remington F., Spellberg B.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:530-532, Aug 4, 2005. Correspondence

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