Multidrug resistant Proteus mirabilis and Escherichia coli causing fulminant necrotising fasciitis: a case report

Abstract

BackgroundNecrotizing fasciitis is a rare soft tissue infection characterized by rapid progressive necrosis with relative sparing of underlying muscles. This case is reported to highlight the emergence of multidrug resistant microbes in recent days which limits the use of empiric antibiotic therapy and necessitates early cultures and sensitivity enabling targeted antibiotic therapy. Factors that lead to antimicrobial resistance especially in sub-Saharan Africa have also been discussed.Case presentationWe report the case of a 52-year-old black man who was referred to our centre for the management of cellulitis and suppurating ulcers of the right leg which had progressed to a wet gangrene. Following physical examination and work-up, a diagnosis of fulminant necrotizing fasciitis of the right leg caused by multidrug resistant Proteus mirabilis and Escherichia coli was made. Despite the broad-spectrum empiric antibiotic therapy and aggressive multiple surgical debridement, necrosis progressed leading to an above-knee amputation.ConclusionNecrotizing fasciitis is a surgical emergency that requires prompt diagnosis and aggressive surgical debridement in order to reduce morbidity and mortality. The emergence of multidrug resistant organisms in recent days have limited the use of empiric antibiotic therapy, necessitating early culture and sensitivity and the use of susceptibility-guided antibiotic therapy. Timely action to control the use of antibiotics in sub-Saharan Africa will reduce multidrug resistance and delay the arrival of post-antibiotics era.

Comparative Epidemiology and Resistance Trends of Proteae in Urinary Tract Infections of Inpatients and Outpatients: A 10-Year Retrospective Study

“…Other last-resort drugs used in severe infections with Gram-negative pathogens, like tigecycline and colistin are not useful in the therapy of Proteae -associated pathologies [36,37]. Several reports on the emergence and spread MDR Proteus and related species have also been published, which is further cause for concern [38,39]. This study presents the changing epidemiology and resistance trends of Proteae associated with urinary tract infections (UTIs) in Hungary over a long surveillance period (10 years), demonstrating a steady increase in the resistance levels regarding various antibiotics.…”

From Fibroids to Fasciitis: A Rare Case of Necrotizing Fasciitis Post-Abdominal Hysterectomy

“…As Proteus mirabilis is one of the leading causes of UTIs, the urinary tract is likely the source of the bacteria that caused the necrotizing fasciitis. While Staphylococcus aureus and Group A Streptococcus are the most common pathogens associated with necrotizing fasciitis, other bacteria such as Proteus mirabilis have been reported in the literature [9,10]. This case highlights the importance of obtaining wound cultures and urine cultures in patients with suspected necrotizing fasciitis, as it may provide important information for guiding antimicrobial therapy.…”

“…Other organisms associated with necrotizing fasciitis include Staphylococcus aureus, Klebsiella pneumoniae, Clostridium perfringens, and Vibrio vulnificus, among others [7,8]. The bacteria invade the subcutaneous tissue and fascia, typically through a breach of the skin, leading to tissue destruction and production of toxins that cause necrosis and systemic inflammatory response syndrome (SIRS) [3,9]. The early signs of necrotizing fasciitis can be subtle and nonspecific, but typically include severe pain at the incision site, fever, erythema, and edema [2,10,11].…”

Polymicrobial Necrotizing Fasciitis in a Dog: The Involvement of Macrococcus caseolyticus, Proteus mirabilis, and Escherichia coli

“…Also worth noting is the possibility that P. mirabilis was a coincidental finding or a contaminant. However, cases of NF in humans have been linked to P. mirabilis [ 15 , 16 ], unlike in dogs. M. caseolyticus , a catalase- and oxidase-positive bacterium, is phylogenetically closely related to the genus Staphylococcus .…”