Fatal Necrotizing Fasciitis Mediated by Escherichia coli After Parotidectomy and Neck Dissection: A Case Report and Review of the Literature

Abstract

Necrotizing soft tissue infection (NSTI) is a rare, but life-threatening, complication of head and neck surgery. We present a 70-year-old male with a history of immunosuppression who presented with polymicrobial NSTI following parotidectomy and neck dissection for cutaneous squamous cell carcinoma. The objective of this report was to promote awareness for NSTI following parotidectomy and selective neck dissection and highlight the management measures that can optimize survival outcomes. We performed a database search that identified 1,025 citations, of which 5 articles described classified as craniocervical necrotizing fasciitis following major head and neck surgery. Consent was obtained from the patient for inclusion in the research study and Institutional Review Board approval was waived. Our literature review yielded 6 cases of craniocervical necrotizing fasciitis following major head and neck surgery. This NSTI, however—unlike the others previously reported—was predominantly mediated by Escherichia coli, a bacterium associated with elevated mortality rates. Despite immediate awake fiberoptic intubation, repeated surgical debridement, and empirical antibiotic therapy, he deteriorated rapidly and was withdrawn from life-support on postoperative day seven. Prophylactic antibiotics, airway management, prompt diagnosis, and surgical debridement are critical for limiting mortality in NSTI of the head and neck.

Skin and soft tissue infection suspiciously caused by Klebsiella pneumoniae in an aquaculture worker: A case report

“…Of note, Escherichia coli, Pseudomonas putida and K. pneumoniae are widely present throughout the natural environment as conditional pathogenic bacteria. Escherichia coli and K. pneumoniae , belonging to the Enterobacteriaceae family, have been reported to be involved in diabetic foot ulcers, necrotizing fasciitis, burn wounds or other necrotizing soft tissue infections ( 14-18 ). As they sometimes may develop into extended spectrum β-lactamase-, carbapenem- and multiple drug-resistant strains, it is better to cultivate bacteria on the surface of ulcers, test drug sensitivity and select appropriate antibiotics ( 14-18 ).…”

“…Escherichia coli and K. pneumoniae , belonging to the Enterobacteriaceae family, have been reported to be involved in diabetic foot ulcers, necrotizing fasciitis, burn wounds or other necrotizing soft tissue infections ( 14-18 ). As they sometimes may develop into extended spectrum β-lactamase-, carbapenem- and multiple drug-resistant strains, it is better to cultivate bacteria on the surface of ulcers, test drug sensitivity and select appropriate antibiotics ( 14-18 ). Pseudomonas putida , also a Gram-negative bacteria, is an uncommon cause of SSTIs.…”