title: Methicillin-resistant Staphylococcus aureus necrotizing pneumonia arising from an infected episiotomy site.
abstract: BACKGROUND
  We report a case of methicillin-resistant Staphylococcus aureus (MRSA) sepsis and pneumonia in a postpartum patient.
  
  
  METHODS
  A 21-year-old gravida 1 para 1 presented on postpartum day 9 with persistent elevated fever, dyspnea, cellulitis of the upper extremities, and an infected episiotomy site. Computed tomography of the chest revealed multiple widely distributed nodules and bilateral infiltrates with central cavitations. Sputum, blood, urine, and episiotomy site cultures grew MRSA, subsequently demonstrated by molecular fingerprinting and antibiotic susceptibility to be community acquired. A magnetic resonance imaging of the pelvis demonstrated pelvic thrombophlebitis.
  
  
  CONCLUSIONS
  Community-acquired MRSA is an emerging problem, which may present as skin and soft tissue infections or sepsis. Seeding from an infected episiotomy site seems to be a potential route of systemic infection. The use of empirical treatment with beta-lactam agents may fail. Appropriate cultures should be obtained and if MRSA is diagnosed, vancomycin should be employed.
authors.affiliation: Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York 11219, USA. mrotas@gmail.com,
authors.forename: Michael
authors.initials: M
authors.lastname: Rotas
authors.forename: Sandra
authors.initials: S
authors.lastname: McCalla
authors.forename: Chunhua
authors.initials: C
authors.lastname: Liu
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004841:Episiotomy; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D016106:Methicillin Resistance; D011023:Pneumonia, Staphylococcal / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D011247:Pregnancy; D011644:Puerperal Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin