Successful treatment of a rare extended retroperitoneal necrotizing soft tissue infection caused by extended-spectrum beta-lactamase-producing Escherichia coli

Abstract

Rationale:Retroperitoneal necrotizing soft tissue infection (NSTI) is a rare but life-threatening disease. Here, we present a case of extended retroperitoneal NSTI caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E coli).Patient concerns:The patient complained of progressive redness, swelling, and right flank pain for 10 days, extending to the scrotum for 1 day.Diagnoses:He was admitted with an initial diagnosis of cellulitis.Interventions:Debridement was performed after the scrotum developed necrosis on day 2 of hospitalization. The source of infection was found to be an idiopathic retroperitoneal abscess, which was confirmed by computed tomography. Two consecutive microbiological cultures (aerobic plus anaerobic) of the tissue revealed the presence of ESBL-producing E coli. With the application of negative pressure wound therapy (NPWT), we sutured the wound after consecutive debridement.Outcomes:During the 32 months of follow-up, the patient recovered very well and felt extremely satisfied.Lessons:This case reminds us that ESBL-producing E coli can cause retroperitoneal abscesses, which may induce NSTI. Aggressive debridement and broad-spectrum antibiotics should be administrated immediately when NSTI is suspected, and NPWT is an effective adjuvant therapy for wound closure.

Case of retroperitoneal necrotising fasciitis: a rare and deadly spread

“…Blood investigations can show an infective picture but imaging modalities are usually employed to determine the presence of inflammation and gas in the subcutaneous tissues 1. Most literature favour using CT scanning as the primary modality for diagnosing RNF with sensitivity reaching 100% which can effectively determine the extent of the involvement of retroperitoneal space as it was in our case 3 4 6 8. CT findings consistent with RNF include asymmetric fascial thickening, oedema and abscess formation.…”

“…The rare extension into the retroperitoneal plane is mostly reported secondary to a traumatic cause such as perforated appendicitis or diverticulitis, pancreatitis, pyelonephritis, gastrodoudenal perforation, necrotic cholecystitis, perforated bowel tumour and various perineal infections and abscesses 1–3 5 6 8. Irrespective of the site, literatures supports the classification of NF into monomicrobial or polymicrobial types 2.…”

“…The term NF comprises a group of potentially lethal infections confined to fascial planes involving the skin, subcutaneous tissue and/or muscles 1–4. The distinguishing feature of this infectious process is its rapid spread within the planes leading to degeneration and eventual necrosis of the tissues at a rate of 2–3 cm/hour 1 4 5.…”

“…Irrespective of the cause, once suspected or confirmed, the treatment of NF or RNF involves radical, extensive and repeated surgical debridement, addressing the underlying cause, NPDs and broad spectrum and later on targeted antimicrobial therapy 2 3 6 8. Surgical debridement is done along all planes which appear necrotic and devitalised until healthy tissue is reached.…”

“…Literature reports benefits of repeated debridement every 24–48 hours and NPD at least three times a week 3 8. Almost all cases of RNF found in literature report high rates of mortality ranging between 10% and 50% being directly related to delay in diagnosis and definitive treatment 4–6 8…”