Incidence and clinical characteristics of methicillin-resistant Staphylococcus aureus necrotizing fasciitis in a large urban hospital.
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) has become a prevalent health issue for soft-tissue infections. In severe soft-tissue infections such as necrotizing fasciitis, MRSA has been identified as an increasingly common pathogen. Herein, we report a 5-year experience of MRSA necrotizing fasciitis at a large urban hospital.


METHODS
All cases of necrotizing fasciitis between 2001 and 2006 were reviewed. All patients were taken for surgical debridement. MRSA patients were identified and compared with the non-MRSA patients to identify any clinical variables that impacted incidence or severity of disease. A P value of less than .05 was considered significant.


RESULTS
During the 5-year period, there were 74 cases of necrotizing fasciitis with a 39% prevalence of MRSA as the causative organism for the infection. The mean age of patients with MRSA fasciitis was 43 +/- 3 years. There were no discernible social variables (eg, smoking, ethanol use, intravenous drug use) that predisposed patients to MRSA infection. The overall mortality rate was 15%, with no significant difference between groups. One hundred percent of MRSA specimens were susceptible to vancomycin or rifampin, 93% were susceptible to sulfamethoxazole/trimethoprim, and only 62% were susceptible to clindamycin.


CONCLUSIONS
The incidence of MRSA fasciitis may be much higher than initially suspected and prompt MRSA-directed antibiotic therapy should be administered. Clinicians should maintain a high index of suspicion for this organism in necrotizing fasciitis.
Lee
Timothy C
TC
Michael E DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
Carrick
Matthew M
MM
Scott
Bradford G
BG
Hodges
Joseph C
JC
Pham
Hoang Q
HQ
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D019115:Fasciitis, Necrotizing / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014640:Vancomycin