Community-Associated Methicillin-Resistant Staphylococcus Aureus Necrotizing Fasciitis in a Neonate

Abstract

Neonatal necrotizing fasciitis is rare and is predominantly associated with methicillin-susceptible Staphylococcus aureus (MSSA). Necrotizing fasciitis associated with community-associated methicillin-resistant S aureus (CA-MRSA) has only recently been reported in the literature, primarily among adults. We present a case of a previously healthy neonate with necrotizing fasciitis of the back caused by CA-MRSA, pulsed-field type USA-300. We describe a 5-day-old infant with necrotizing fasciitis of the back caused by CA-MRSA. Treatment of necrotizing fasciitis requires prompt medical evaluation, prompt surgical debridement, and appropriate antibiotic selection. The potential involvement of CA-MRSA in necrotizing fasciitis in children needs to be considered before institution of antibiotics.

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

“…The majority of the isolates were USA300 MRSA strains but were resistant to clindamycin and ciprofloxacin (803). Cases of severe, fatal neonatal MRSA pneumonia caused by USA300 have also been reported among neonates (590,1019), as has necrotizing fasciitis (224).…”

“…Infectious foci should be drained, and necrotic tissue should be debrided when feasible (7,87,159,224,379,523,525,609,1021).…”

Management of Skin and Soft-Tissue Infections in the Emergency Department

“…Recent reports (mostly case reports and case series) of necrotizing SSTIs caused by CA-MRSA have revealed that this type of necrotizing SSTI presents more subacutely and is a more benign syndrome than necrotizing infections caused by other etiologies [13,[42][43][44]. In a retrospective study of 14 patients with necrotizing SSTIs, 57% of patients had a preoperative diagnosis of abscess, and necrotizing infection was not suspected [13].…”

Recent Advances in the Treatment of Necrotizing Fasciitis

“…The inclusion of antimicrobials effective against MRSA in suspected staphylococcal infection is recommended for high-risk patients (eg frequent hospital attendees or residents of long-term care facilities), and for neonates and children as well [18,20]. With a history of "spider bite" or recurrent skin sepsis, CA-MRSA should be suspected and the addition of vancomycin, daptomycin, or linezolid is recommended.…”

“…Methicillin-resistant Staphylococcus aureus (MRSA) NF, [8][9][10][11][12] including Fournier's gangrene [15], is now increasingly reported, especially with the spread of community-associated MRSA (CA-MRSA) [16][17][18][19][20][21]. CA-MRSA NF can cause purpura fulminans easily confused with meningococcal septicaemia clinically [21].…”