title: Successful treatment of a rare extended retroperitoneal necrotizing soft tissue infection caused by extended-spectrum beta-lactamase-producing Escherichia coli: A case report.
abstract: BACKGROUND
  Retroperitoneal necrotizing soft tissue infection (NSTI) is a rare but life-threatening disease. Here, we present a case of extended retroperitoneal NSTI caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E coli).
  
  
  METHODS
  The patient complained of progressive redness, swelling, and right flank pain for 10 days, extending to the scrotum for 1 day.
  
  
  METHODS
  He was admitted with an initial diagnosis of cellulitis.
  
  
  METHODS
  Debridement was performed after the scrotum developed necrosis on day 2 of hospitalization. The source of infection was found to be an idiopathic retroperitoneal abscess, which was confirmed by computed tomography. Two consecutive microbiological cultures (aerobic plus anaerobic) of the tissue revealed the presence of ESBL-producing E coli. With the application of negative pressure wound therapy (NPWT), we sutured the wound after consecutive debridement.
  
  
  RESULTS
  During the 32 months of follow-up, the patient recovered very well and felt extremely satisfied.
  
  
  CONCLUSIONS
  This case reminds us that ESBL-producing E coli can cause retroperitoneal abscesses, which may induce NSTI. Aggressive debridement and broad-spectrum antibiotics should be administrated immediately when NSTI is suspected, and NPWT is an effective adjuvant therapy for wound closure.
authors.affiliation: Department of Plastic Surgery and Burn Department of Anti-infection Department of Radiology, Peking University First Hospital, Beijing, People's Republic of China.
authors.forename: Rui
authors.initials: R
authors.lastname: He
authors.forename: Xin
authors.initials: X
authors.lastname: Qi
authors.forename: Bing
authors.initials: B
authors.lastname: Wen
authors.forename: XiangYan
authors.initials: X
authors.lastname: Li
authors.forename: Li
authors.initials: L
authors.lastname: Guo
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods*; D004359:Drug Therapy, Combination; D004926:Escherichia coli / Q000201:enzymology*; D004927:Escherichia coli Infections / Q000175:diagnosis / Q000628:therapy*; D019115:Fasciitis, Necrotizing / Q000382:microbiology* / Q000473:pathology / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D035583:Rare Diseases; D012187:Retroperitoneal Space; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases