Mrsa necrotizing Fasciitis in a Neonate Mei-Lin T. Pang md, Carla T. Lee Md



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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

  • Children’s Hospital San Diego

  • July 8, 2006


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


History of Present Illness

  • Hospital course: hypoxia, hypotension

    •  intubation, pressors, PICU
  • Pediatric dermatology consult re: progressive induration and erythema of the lumbar puncture site





Necrotizing fasciitis (NF)



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


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



References

  • 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 1999;103:e53. Available at: http://www.pediatrics.org/cgi/content/103/4/e53.

  • Nazir Z. Necrotizing fasciitis in neonates. Pediatr Surg Int. 2005;21:641-644.

  • Purcell K, Fergie J. Epidemic of community-acquired methicillin resistant Staphylococcus aureus infections. Arch Pediatr Adolesc Med. 2005;159:980-985.





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