MRSA Necrotizing Fasciitis in a Neonate

1
MRSA Necrotizing Fasciitis in a Neonate

• Mei-Lin T. Pang MD, Carla T. Lee MD,
• Brandie J. Metz MD, Sheila F. Friedlander MD,
• Victoria R. Barrio MD, Lawrence F. Eichenfield MD
• Childrens Hospital San Diego
• July 8, 2006

2
History of Present Illness

• 5 d.o. male -- T 101º F fussiness
• FT NSVD abdominal pustule --DOL3, spontaneously
  resolved
• ER evaluation Irritable, no focal findings
• Sepsis w/u unsuccessful LP
• Noted on admission
• 2 cm poorly defined subtle induration and
  erythema noted at site of lumbar puncture

3
History of Present Illness

• Hospital course hypoxia, hypotension
• ? intubation, pressors, PICU
• Pediatric dermatology consult re progressive
  induration and erythema of the lumbar puncture
  site

4
(No Transcript)
5
Necrotizing fasciitis (NF)

• Potentially fatal bacterial infection of soft
  tissue
• --rapidly progressive tissue edema, inflammation,
  and sytemic toxicity
• Prompt surgical debridement mandatory

6
Neonatal Necrotizing Fasciitis

• Less than 70 cases in the literature
• 2 series Taiwan and Pakistan (12 patients)
• Commonly truncal abdominal wall most common
• Mortality close to 50
• Associations
• --omphalitis
• --balanitis
• --mastitis
• --postoperative complications
• --fetal monitoring

Hsieh W et al, Pediatrics (1999) Nazir Z, Pediatr
Surg Int (2005)
7
Neonatal NF

• Usually polymicrobial
• staph predominant organism
• Rare cases of MRSA
• 60 increase in MRSA - U.S. Hospitals
• Rx Vancomycin for all cases of necrotizing
  fasciitis in communities with high rates of MRSA

Purcell K et al. Arch Pediatr Adolesc Med.
(2005)
8
References

1. Hsieh W, Yang P, Chao H, et al. Neonatal
   necrotizing fasciitis A report of three cases
   and review of the literature. Pediatrics.
   serial online. April 1999103e53. Available
   at http//www.pediatrics.org/cgi/content/103/4/e
   53.
2. Nazir Z. Necrotizing fasciitis in neonates.
   Pediatr Surg Int. 200521641-644.
3. Purcell K, Fergie J. Epidemic of
   community-acquired methicillin resistant
   Staphylococcus aureus infections. Arch Pediatr
   Adolesc Med. 2005159980-985.