Necrotizing fasciitis in a newborn infant: a case report

Abstract

We report the case of a one-day-old newborn infant, female, birth weight 1900 g, gestational age 36 weeks presenting with necrotizing fasciitis caused by E. coli and Morganella morganii. The newborn was allowed to fall into the toilet bowl during a domestic delivery. The initial lesion was observed at 24 hours of life on the left leg at the site of the venipuncture for the administration of hypertonic glucose solution. Despite early treatment, a rapid progression occurred resulting in a fatal outcome. We call attention to the risk presented by this serious complication in newborns with a contaminated delivery, and highlight the site of the lesion and causal agents. Necrotizing fasciitis occurs predominantly in adult patients. The initiating site is usually a local trauma or a surgical wound. In children, the disease is not common; however, frequently the clinical course is fatal 1 . The mortality rate among pediatric patients ranges from 10% to 60% 2 . During the neonatal period, the occurrence of necrotizing fasciitis is rare and is generally associated with other infections, such as omphalitis and mammary infection 3 . Mortality is high, reaching over 70%, even with precocious diagnosis and treatment 4 . These aspects of the disease's behavior demonstrate the importance of bearing in mind the predisposing factors and rigorous vigilance needed to treat the at-risk newborn. This case report describes our experience with a newborn with necrotizing fasciitis that followed a massive contamination during the delivery. CASE REPORTThe patient was a one-day-old girl, with a birth weight of 1900 g and a gestational age 36 weeks. The mother was 29 years old, and this was her second gestation without prenatal care. The birth took place at home, and the newborn was allowed to fall into the toilet bowl during delivery; the umbilical cord was severed with domestic scissors. Shortly after birth, the newborn was taken to the hospital where she received her first medical care and intravenous penicillin and amikacin therapy. At 90 minutes of life, she presented with hypoglycemia, necessitating intravenous infusion of 10% glucose. At 24 hours of life, hyperemia and edema of the left leg were observed at the site of the venipuncture and infiltration of intravenous solution. The clinical course was marked by a rapid deterioration of the lesion's appearance and extension. The infant was transferred to the Neonatal Intensive Care Unit (NICU) of the Children's Institute because of her worsening clinical course. On admission, she was in a poor general state, groaning, with decreased peripheral perfusion, an axillary temperature of 36°C, tachycardia (160 beats/min), tachypnea (88 breaths/min), abdominal distention, her

Virulence Potential of Escherichia coli Isolates from Skin and Soft Tissue Infections

“…The most common causative agents are Staphylococcus aureus and aerobic streptococci (9, 10, 41, 43). However, several reports associating the enterobacterium Escherichia coli with SSTI have been published: E. coli was found to be the causative agent of neonatal omphalitis (7), cellulitis localized to lower or upper limbs (4, 6, 49), necrotizing fasciitis (1,25,28), surgical site infections (44), infections after burn injuries (37), and others. A study monitoring SSTIs during a 7-year period and encompassing three continents (Europe, Latin America, and North America) showed E. coli to be an important causative agent, since it was the third-most prevalent isolated species, preceded solely by S. aureus and Pseudomonas aeruginosa.…”

Necrotising fasciitis associated withEscherichia coliin a dog

“…Streptococcal NF was reported in eight dogs from Canada (Miller et al 1996;Prescott et al 1997) but, to our knowledge, NF associated with E. coli has not been reported previously in dogs. Escherichia coli has been recognised as the sole causal organism in cases of NF in humans (Rehman et al 1998;Krebs et al 2001), but is more commonly reported as part of a mixed infection (Brook 1996). Extensive necrosis associated with E. coli is often attributed to microbial synergism (Rehman et al 1998).…”

“…NF is an infection of the skin, S/C fat, and superfi cial to deep fascia, and there is rapid dissemination and signs of systemic toxicity (Krebs et al 2001). A variety of bacteria and fungi have been implicated as causal organisms in cases of NF (Brook 1996;Stevens 2000;Goodell et al 2004).…”

Neonatal Morganella morganii sepsis: a case report and review of the literature

“…However, extensive use of intrapartum antibiotics has been associated with major changes in the spectrum of organisms involved and their susceptibility to antibiotics. Morganella morganii is rarely encountered but may cause serious invasive infection in the pregnant woman or neonate 1–10 . This organism is characteristically resistant to many beta‐lactam antibiotics which may lead to delays in proper treatment.…”