title: Necrotizing fasciitis due to penicillin-resistant Streptococcus pneumoniae: case report and review of the literature.
abstract: Necrotizing fasciitis (NF) is a life-threatening infection involving rapid necrosis of subcutaneous and fascial tissues. Streptococcus pneumoniae (SPN) soft tissue infection is exceedingly uncommon, reported primarily in patients with immunosuppression or other underlying conditions. We report a case of NF and septic shock in a healthy 32-year-old man, whose only predisposing factor was antecedent blunt trauma. Pathological examination and culture of the extensive tissue debridement were positive only for SPN. The serotype 9V isolate was penicillin (PCN)-resistant (MIC=2.0), and closely-related by pulse field gel electrophoresis and multilocus fingerprinting to clone France 9V-3, an important genetic reservoir for increasing PCN-resistance worldwide. This unique case has implications for our pathogenic under-standing and empiric management of NF.
authors.affiliation: Department of Medicine, Scripps Mercy Hospital, San Diego, CA, USA.
authors.forename: G R
authors.initials: GR
authors.lastname: Ballon-Landa
authors.forename: G
authors.initials: G
authors.lastname: Gherardi
authors.forename: B
authors.initials: B
authors.lastname: Beall
authors.forename: S
authors.initials: S
authors.lastname: Krosner
authors.forename: V
authors.initials: V
authors.lastname: Nizet
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D016521:Electrophoresis, Gel, Pulsed-Field; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D007121:Immunocompetence; D008297:Male; D010403:Penicillin Resistance; D012772:Shock, Septic / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D014949:Wounds, Nonpenetrating / Q000150:complications
chemical_list: D000900:Anti-Bacterial Agents