title: Sequential necrotizing fasciitis caused by the monomicrobial pathogens Streptococcus equisimilis and extended-spectrum beta-lactamase-producing Escherichia coli.
abstract: Necrotizing fasciitis is a rapidly progressing bacterial infection of the superficial fascia and subcutaneous tissue that is associated with a high mortality rate and is caused by a single species of bacteria or polymicrobial organisms. Escherichia coli is rarely isolated from patients with monomicrobial disease. Further, there are few reports of extended-spectrum beta-lactamase (ESBL)-producing E. coli associated with necrotizing fasciitis. We report here our treatment of an 85-year-old man who was admitted because of necrotizing fasciitis of his right thigh. Streptococcus equisimilis was detected as a monomicrobial pathogen, and the infection was cured by amputation of the patient's right leg and the administration of antibiotics. However, 5 days after discontinuing antibiotic therapy, he developed necrotizing fasciitis on his right upper limb and died. ESBL-producing E. coli was the only bacterial species isolated from blood and skin cultures. This case demonstrates that ESBL-producing E. coli can cause monomicrobial necrotizing fasciitis, particularly during hospitalization and that a different bacterial species can cause disease shortly after a previous episode.
authors.affiliation: Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Endo
authors.affiliation: Department of Pathology, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Matsuoka
authors.affiliation: Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Mizuno
authors.affiliation: Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan; Department of Infectious Disease, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan.
authors.forename: Asako
authors.initials: A
authors.lastname: Doi
authors.affiliation: Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan; Department of Infectious Disease, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan. Electronic address: nishiokahiroaki@hotmail.com.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nishioka
mesh_terms: D000369:Aged, 80 and over; D004926:Escherichia coli / Q000302:isolation & purification* / Q000378:metabolism; D004927:Escherichia coli Infections / Q000382:microbiology*; D019115:Fasciitis, Necrotizing / Q000382:microbiology*; D006801:Humans; D008297:Male; D013290:Streptococcal Infections / Q000382:microbiology*; D013291:Streptococcus / Q000302:isolation & purification*; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases
keywords: ESBL-Producing Escherichia coli; Monomicrobial; Necrotizing fasciitis; Sequential