Cervicofacial necrotising fasciitis by clindamycin-resistant and methicillin-resistantStaphylococcus aureus(MRSA) in a young healthy man

Abstract

An otherwise healthy 24-year-old man presented with 1 week of fever, facial pain and swelling. He initially sought care at an outside hospital, where he was diagnosed with folliculitis and sent home with oral antibiotics. On arrival at our institution, CT neck was ordered, which demonstrated diffuse submental phlegmon, prompting incision and drainage. After initial improvement, the patient experienced high fevers and increased swelling just 12 hours later. The decision was made to take the patient for operative exploration, and wide debridement was performed due to suspicion for necrotising fasciitis intraoperatively that was ultimately confirmed on final pathology. Final speciation of intraoperative culture demonstrated a clindamycin-resistant and methicillin-resistant strain of Staphylococcus aureus. The patient was managed with intravenous antibiotics, additional debridement and careful wound care. Delayed partial closure of wound was eventually performed once patient showed marked and persistent clinical improvement. The patient was discharged on hospital day 12 with close follow-up.

Multidisciplinary treatment of a patient with necrotizing fasciitis caused by Staphylococcus aureus: A case report

“…It is essential to be alert to these symptoms because the earlier diagnosis of NF results in better outcomes and fewer complications[12]. Systemic clinical symptoms include fever, toxic delirium, typical signs of shock (tachycardia and hypotension), and eventually multi-organ dysfunction[13-15]. According to the current literature, the incidence of NF is relatively low, but the reported total mortality rate is as high as 20%[7].…”