A difficult case of necrotizing fasciitis caused by Acinetobacter baumannii.
This study reports the case of a 55-year-old woman with diabetes with a necrotizing fasciitis of the right lower limb and the perineum, first admitted at the emergency department for septic shock with cardiac arrest, and later transferred to the department of surgery. Microbiological and histopathological examination confirmed the diagnosis of necrotizing fasciitis caused by Acinetobacter baumannii. A broad-spectrum antibiotic therapy was administered and later readjusted according to the results of microbiological culture. Intensive hemodynamic support was required. Wounds were dressed daily with a 3 percent boric acid solution and a silver sulfadiazine-impregnated dressing. An extensive surgical debridement was promptly performed and repeated until complete control of the infection. Wounds were finally covered with split-thickness skin grafts. The infection was overcome 35 days after admission. The graft take was 100%. Postoperative rehabilitation was required because of the functional limitation of lower limb movements. Follow-up at 6 months showed no functional deficit and an acceptable aesthetic result. Necrotizing fasciitis is a life-threatening disorder, especially in patients with diabetes, whose clinical diagnosis may sometimes be challenging. Early recognition and treatment represent the most important factors influencing survival.
Dipartimento di Discipline Chirurgiche e Oncologiche, Sezione di Chirurgia Plastica, Università degli Studi di Palermo, Italy.
Bartolo
B
Corradino
Francesca
F
Toia
Sara
S
di Lorenzo
Adriana
A
Cordova
Francesco
F
Moschella
D000151:Acinetobacter Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D040981:Acinetobacter baumannii / Q000302:isolation & purification*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D001888:Boric Acids / Q000627:therapeutic use; D003646:Debridement; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006323:Heart Arrest; D006801:Humans; D007306:Insecticides / Q000627:therapeutic use; D008875:Middle Aged; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012772:Shock, Septic; D012837:Silver Sulfadiazine / Q000627:therapeutic use; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*
D000891:Anti-Infective Agents, Local; D001888:Boric Acids; D007306:Insecticides; C032688:boric acid; D012837:Silver Sulfadiazine