Necrotizing Fasciitis Due to Penicillin-resistant Streptococcus pneumoniae: Case Report and Review of the Literature

Ballon-Landa, Gonzalo; Gherardi, Giovanni; Beall, Bernard; Krosner, S.; Nizet, Victor

doi:10.1053/jinf.2000.0801

Cited by 19 publications

(18 citation statements)

References 51 publications

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“…Necrotizing fasciitis is not so rare, but necrotizing fasciitis due to S. pneumonia is exceedingly rare: we found only 19 reported cases, including the present report (3-17). Ages ranged from 21-83 yr, with an average of 50.1 yr (Table 1).…”

Section: Discussioncontrasting

confidence: 49%

Fatal Necrotizing Fasciitis Due toStreptococcus pneumoniae: A Case Report

Park

Moon

et al. 2011

J Korean Med Sci

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Necrotizing fasciitis is known to be a highly lethal infection of deep-seated subcutaneous tissue and superficial fascia. Reports of necrotizing fasciitis due to Streptococcus pneumoniae are exceedingly rare. We report a case of necrotizing fasciitis in a 62-yr-old man with liver cirrhosis and diabetes mellitus. He presented with painful swelling of left leg and right hand. On the day of admission, compartment syndrome was aggravated and the patient underwent surgical exploration. Intra-operative findings revealed necrotizing fasciitis and cultures of two blood samples and wound aspirates showed S. pneumoniae. The patient died despite debridement and proper antimicrobial treatment. To the best of our knowledge, this is the first case of fatal necrotizing fasciitis with meningitis reported in Korea. We also review and discuss the literature on pneumococcal necrotizing fasciitis.

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Section: Discussioncontrasting

confidence: 49%

Fatal Necrotizing Fasciitis Due toStreptococcus pneumoniae: A Case Report

Park

Moon

et al. 2011

J Korean Med Sci

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“…S. pneumoniae, which was dominant in samples from patient 8, is a widespread pathogen that displays enormous heterogeneity with respect to phenotype and pathogenicity, and has been implicated in community-acquired pneumonia, sinusitis, otitis media, orthopaedic infections and meningitis [44, 60–62]. NSTI due to S. pneumoniae is rare and has primarily been reported in cases where patients were immunosuppressed or had other underlying conditions [21, 63–67], which does not correspond to the patient history in this case (Table 1). However, serious infections upon septic spread of the S. pneumoniae including to joints and bursas, as in this case, is not unusual.…”

Section: Discussionmentioning

confidence: 99%

Comparing culture and molecular methods for the identification of microorganisms involved in necrotizing soft tissue infections

Rudkjøbing

Thomsen

et al. 2016

BMC Infect Dis

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BackgroundNecrotizing soft tissue infections (NSTIs) are a group of infections affecting all soft tissues. NSTI involves necrosis of the afflicted tissue and is potentially life threatening due to major and rapid destruction of tissue, which often leads to septic shock and organ failure. The gold standard for identification of pathogens is culture; however molecular methods for identification of microorganisms may provide a more rapid result and may be able to identify additional microorganisms that are not detected by culture.MethodsIn this study, tissue samples (n = 20) obtained after debridement of 10 patients with NSTI were analyzed by standard culture, fluorescence in situ hybridization (FISH) and multiple molecular methods. The molecular methods included analysis of microbial diversity by 1) direct 16S and D2LSU rRNA gene Microseq 2) construction of near full-length 16S rRNA gene clone libraries with subsequent Sanger sequencing for most samples, 3) the Ibis T5000 biosensor and 4) 454-based pyrosequencing. Furthermore, quantitative PCR (qPCR) was used to verify and determine the relative abundance of Streptococcus pyogenes in samples.ResultsFor 70 % of the surgical samples it was possible to identify microorganisms by culture. Some samples did not result in growth (presumably due to administration of antimicrobial therapy prior to sampling). The molecular methods identified microorganisms in 90 % of the samples, and frequently detected additional microorganisms when compared to culture. Although the molecular methods generally gave concordant results, our results indicate that Microseq may misidentify or overlook microorganisms that can be detected by other molecular methods.Half of the patients were found to be infected with S. pyogenes, but several atypical findings were also made including infection by a) Acinetobacter baumannii, b) Streptococcus pneumoniae, and c) fungi, mycoplasma and Fusobacterium necrophorum.ConclusionThe study emphasizes that many pathogens can be involved in NSTIs, and that no specific “NSTI causing” combination of species exists. This means that clinicians should be prepared to diagnose and treat any combination of microbial pathogens. Some of the tested molecular methods offer a faster turnaround time combined with a high specificity, which makes supplemental use of such methods attractive for identification of microorganisms, especially for fulminant life-threatening infections such as NSTI.

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“…The Streptococcus pneumoniae strain isolated from our patient was susceptible to penicillin, but a penicillinresistant strain was recently reported to have caused necrotizing fasciitis, another serious soft-tissue infection [11]. Although low-level resistance to penicillin can be overcome with a high dosage of intravenous penicillin G for infections not involving meningitis, the possibility of resistance in this organism must always be considered until susceptibility can be demonstrated.…”

Section: Discussionmentioning

confidence: 83%