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Narayan M, Juprasert J, Finn C, Barie PS. Recurrent Necrotizing Soft Tissue Infections with Atypical Pathogens after Injection Drug Abuse: Another Manifestation of the Opioid Crisis. Surg Infect (Larchmt) 2020; 21:411-415. [PMID: 31910356 DOI: 10.1089/sur.2019.187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: The United States is in the midst of an opioid crisis. Injection drug use is a major risk factor for necrotizing soft tissue infections (NSTI) by introducing bacteria into the soft tissues. Repetitive infection and atypical pathogens may be tangible manifestations of the opioid crisis. Methods: We describe recidivism in two cases of NSTI involving opioid abuse and atypical pathogens at a single institution and review pertinent international literature. Results: Repetitive NSTI is rare. Patients with chronic injection drug use, however, may be at particular risk of repetitive NSTI and infections with atypical organisms. Conclusions: Care providers must have a heightened awareness of infections with atypical pathogens and risk of repetitive infection in patients with injection drug use. Aggressive surgical management and antibiotic coverage tailored to culture and susceptibility data are necessary for a successful short-term outcome. A successful long-term outcome mandates identification and management of co-existent behavioral health issues.
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Affiliation(s)
- Mayur Narayan
- Department of Surgery, Division of Trauma, Burns, Acute and Critical Care, Division of Medical Ethics, Weill Cornell Medicine, New York, New York, USA
| | - Jackly Juprasert
- Department of Surgery, Division of Trauma, Burns, Acute and Critical Care, Division of Medical Ethics, Weill Cornell Medicine, New York, New York, USA
| | - Caitlin Finn
- Department of Surgery, Division of Trauma, Burns, Acute and Critical Care, Division of Medical Ethics, Weill Cornell Medicine, New York, New York, USA
| | - Philip S Barie
- Department of Surgery, Division of Trauma, Burns, Acute and Critical Care, Division of Medical Ethics, Weill Cornell Medicine, New York, New York, USA.,Department of Medicine, Division of Medical Ethics, Weill Cornell Medicine, New York, New York, USA
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Endo A, Matsuoka R, Mizuno Y, Doi A, Nishioka H. Sequential necrotizing fasciitis caused by the monomicrobial pathogens Streptococcus equisimilis and extended-spectrum beta-lactamase-producing Escherichia coli. J Infect Chemother 2016; 22:563-6. [PMID: 26912298 DOI: 10.1016/j.jiac.2016.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/13/2016] [Accepted: 01/21/2016] [Indexed: 11/19/2022]
Abstract
Necrotizing fasciitis is a rapidly progressing bacterial infection of the superficial fascia and subcutaneous tissue that is associated with a high mortality rate and is caused by a single species of bacteria or polymicrobial organisms. Escherichia coli is rarely isolated from patients with monomicrobial disease. Further, there are few reports of extended-spectrum beta-lactamase (ESBL)-producing E. coli associated with necrotizing fasciitis. We report here our treatment of an 85-year-old man who was admitted because of necrotizing fasciitis of his right thigh. Streptococcus equisimilis was detected as a monomicrobial pathogen, and the infection was cured by amputation of the patient's right leg and the administration of antibiotics. However, 5 days after discontinuing antibiotic therapy, he developed necrotizing fasciitis on his right upper limb and died. ESBL-producing E. coli was the only bacterial species isolated from blood and skin cultures. This case demonstrates that ESBL-producing E. coli can cause monomicrobial necrotizing fasciitis, particularly during hospitalization and that a different bacterial species can cause disease shortly after a previous episode.
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Affiliation(s)
- Akiko Endo
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Ryosuke Matsuoka
- Department of Pathology, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Yasushi Mizuno
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Asako Doi
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan; Department of Infectious Disease, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Hiroaki Nishioka
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan; Department of Infectious Disease, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan.
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Necrotizing Fasciitis in Paroxysmal Nocturnal Hemoglobinuria. Case Rep Hematol 2015; 2015:908087. [PMID: 26347833 PMCID: PMC4548098 DOI: 10.1155/2015/908087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 11/17/2022] Open
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, progressive, and life-threatening hematopoietic stem cell disorder characterized by complement-mediated intravascular hemolysis and a prothrombotic state. Patients with PNH might have slightly increased risk of infections due to complement-associated defects subsequent to CD59 deficiency. Here, we report a rare case of a 65-year-old male patient with necrotic ulcers on both legs, where the recognition of pancytopenia and microthrombi led to the diagnosis of PNH based on FLAER (FLuorescent AERolysin) flow cytometric analysis. He was subsequently started on eculizumab therapy, with starting and maintenance doses set as per drug labelling. Progression of the patient's leg ulcers during follow-up, with fulminant tissue destruction, purulent discharge, and necrotic patches, led to a later diagnosis of necrotizing fasciitis due to Pseudomonas aeruginosa and Klebsiella pneumonia infection. Courses of broad-spectrum antibiotics, surgical debridement, and superficial skin grafting were applied with successful effect during ongoing eculizumab therapy. This case highlights the point that it is important to maintain treatment of underlying disorders such as PNH in the presence of life-threatening infections like NF.
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Morgan M. Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect 2010; 75:249-57. [DOI: 10.1016/j.jhin.2010.01.028] [Citation(s) in RCA: 173] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 01/13/2010] [Indexed: 01/22/2023]
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Wong CH, Tan SH, Kurup A, Tan ABH. Recurrent necrotizing fasciitis caused by methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 2004; 23:909-11. [PMID: 15599653 DOI: 10.1007/s10096-004-1237-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2004] [Indexed: 10/26/2022]
Abstract
Reported here is a rare case of recurrent necrotizing fasciitis due to methicillin-resistant Staphylococcus aureus (MRSA). A 46-year-old female with poorly controlled diabetes and chronic ingestion of steroid-containing medications was admitted for treatment of necrotizing fasciitis of the right thigh. Three months following hospital discharge she was readmitted with necrotizing fasciitis of the left hand. On both occasions, MRSA was isolated from tissue cultures obtained during surgical debridement. Patients who develop necrotizing fasciitis are predisposed to severe soft tissue infections due to associated comorbid conditions such as diabetes mellitus. Recurrent soft tissue infection in a patient with previous MRSA-related necrotizing fasciitis should therefore be treated with a high index of suspicion.
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Affiliation(s)
- C-H Wong
- Department of Hand Surgery, Singapore General Hospital, Singapore.
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Affiliation(s)
- N Jallali
- Royal Free Hampstead NHS Trust, London, UK.
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