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MRSA Necrotizing Fasciitis in a Neonate

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 101 º F & “fussiness”

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MRSA Necrotizing Fasciitis in a Neonate

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  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 Children’s 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. Necrotizing fasciitis (NF) • Potentially fatal bacterial infection of soft tissue --rapidly progressive tissue edema, inflammation, and sytemic toxicity • Prompt surgical debridement mandatory

  5. 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)

  6. 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)

  7. 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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