Monomicrobial necrotizing fasciitis caused by coagulase-negative Staphylococci and methicillin-resistant Staphylococcus aureus

Shih Hsun Shen, Kuo Chin Huang, Chin Chang Cheng, Tsung Jen Huang, Robert Wen Wei Hsu, Yao Hung Tsai

Research output: Contribution to journalArticle

Abstract

Background Coagulase-negative staphylococci (CoNS) have been reported to cause necrotizing fasciitis; however, there are some difficulties in differentiating the roles of CoNS infections as contaminants or pathogenic isolates. Methicillin-resistant S. aureus (MRSA) has emerged as the most common isolate to cause necrotizing fasciitis in the past decade. This study was to compare the clinical presentation and surgical outcome of CoNS and MRSA monomicrobial necrotizing fasciitis, and to assess the prevalence of CoNS and MRSA infection in diabetic patients. Methods Necrotizing fasciitis caused by CoNS in 11 patients and that caused by MRSA in 27 patients was retrospectively reviewed. Demographic data, underlying diseases, laboratory results, and clinical outcome were analyzed for each patient in two groups. Results All patients underwent fasciotomy and received broad-spectrum antibiotic therapy. The mortality of MRSA group and CoNS group was 18.5 and 9%, respectively. Mortality, patient characteristics, clinical presentations, and laboratory data did not differ significantly between the two groups. Eight of CoNS patients (73%) and fourteen of MRSA patients (52%) had significant association with diabetes mellitus. Conclusions Necrotizing fasciitis caused by CoNS is a surgical emergency and should be considered to be serious as that caused by MRSA. Diabetic patients with a history of abrasion injury or chronic ulcer should be cautioned about the risk of developing CoNS and MRSA necrotizing fasciitis.

Original languageEnglish
Pages (from-to)365-371
Number of pages7
JournalEuropean Journal of Orthopaedic Surgery and Traumatology
Volume22
Issue number5
DOIs
Publication statusPublished - Jul 2012
Externally publishedYes

Fingerprint

Necrotizing Fasciitis
Coagulase
Methicillin-Resistant Staphylococcus aureus
Staphylococcus
Mortality
Infection
Ulcer
Diabetes Mellitus
Emergencies
Demography
Anti-Bacterial Agents

Keywords

  • Coagulase-negative staphylococci
  • Fasciotomy
  • Methicillin- resistent Staphylococcus aureus
  • Necrotizing fasciitis

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Monomicrobial necrotizing fasciitis caused by coagulase-negative Staphylococci and methicillin-resistant Staphylococcus aureus. / Shen, Shih Hsun; Huang, Kuo Chin; Cheng, Chin Chang; Huang, Tsung Jen; Hsu, Robert Wen Wei; Tsai, Yao Hung.

In: European Journal of Orthopaedic Surgery and Traumatology, Vol. 22, No. 5, 07.2012, p. 365-371.

Research output: Contribution to journalArticle

Shen, Shih Hsun ; Huang, Kuo Chin ; Cheng, Chin Chang ; Huang, Tsung Jen ; Hsu, Robert Wen Wei ; Tsai, Yao Hung. / Monomicrobial necrotizing fasciitis caused by coagulase-negative Staphylococci and methicillin-resistant Staphylococcus aureus. In: European Journal of Orthopaedic Surgery and Traumatology. 2012 ; Vol. 22, No. 5. pp. 365-371.
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abstract = "Background Coagulase-negative staphylococci (CoNS) have been reported to cause necrotizing fasciitis; however, there are some difficulties in differentiating the roles of CoNS infections as contaminants or pathogenic isolates. Methicillin-resistant S. aureus (MRSA) has emerged as the most common isolate to cause necrotizing fasciitis in the past decade. This study was to compare the clinical presentation and surgical outcome of CoNS and MRSA monomicrobial necrotizing fasciitis, and to assess the prevalence of CoNS and MRSA infection in diabetic patients. Methods Necrotizing fasciitis caused by CoNS in 11 patients and that caused by MRSA in 27 patients was retrospectively reviewed. Demographic data, underlying diseases, laboratory results, and clinical outcome were analyzed for each patient in two groups. Results All patients underwent fasciotomy and received broad-spectrum antibiotic therapy. The mortality of MRSA group and CoNS group was 18.5 and 9{\%}, respectively. Mortality, patient characteristics, clinical presentations, and laboratory data did not differ significantly between the two groups. Eight of CoNS patients (73{\%}) and fourteen of MRSA patients (52{\%}) had significant association with diabetes mellitus. Conclusions Necrotizing fasciitis caused by CoNS is a surgical emergency and should be considered to be serious as that caused by MRSA. Diabetic patients with a history of abrasion injury or chronic ulcer should be cautioned about the risk of developing CoNS and MRSA necrotizing fasciitis.",
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N2 - Background Coagulase-negative staphylococci (CoNS) have been reported to cause necrotizing fasciitis; however, there are some difficulties in differentiating the roles of CoNS infections as contaminants or pathogenic isolates. Methicillin-resistant S. aureus (MRSA) has emerged as the most common isolate to cause necrotizing fasciitis in the past decade. This study was to compare the clinical presentation and surgical outcome of CoNS and MRSA monomicrobial necrotizing fasciitis, and to assess the prevalence of CoNS and MRSA infection in diabetic patients. Methods Necrotizing fasciitis caused by CoNS in 11 patients and that caused by MRSA in 27 patients was retrospectively reviewed. Demographic data, underlying diseases, laboratory results, and clinical outcome were analyzed for each patient in two groups. Results All patients underwent fasciotomy and received broad-spectrum antibiotic therapy. The mortality of MRSA group and CoNS group was 18.5 and 9%, respectively. Mortality, patient characteristics, clinical presentations, and laboratory data did not differ significantly between the two groups. Eight of CoNS patients (73%) and fourteen of MRSA patients (52%) had significant association with diabetes mellitus. Conclusions Necrotizing fasciitis caused by CoNS is a surgical emergency and should be considered to be serious as that caused by MRSA. Diabetic patients with a history of abrasion injury or chronic ulcer should be cautioned about the risk of developing CoNS and MRSA necrotizing fasciitis.

AB - Background Coagulase-negative staphylococci (CoNS) have been reported to cause necrotizing fasciitis; however, there are some difficulties in differentiating the roles of CoNS infections as contaminants or pathogenic isolates. Methicillin-resistant S. aureus (MRSA) has emerged as the most common isolate to cause necrotizing fasciitis in the past decade. This study was to compare the clinical presentation and surgical outcome of CoNS and MRSA monomicrobial necrotizing fasciitis, and to assess the prevalence of CoNS and MRSA infection in diabetic patients. Methods Necrotizing fasciitis caused by CoNS in 11 patients and that caused by MRSA in 27 patients was retrospectively reviewed. Demographic data, underlying diseases, laboratory results, and clinical outcome were analyzed for each patient in two groups. Results All patients underwent fasciotomy and received broad-spectrum antibiotic therapy. The mortality of MRSA group and CoNS group was 18.5 and 9%, respectively. Mortality, patient characteristics, clinical presentations, and laboratory data did not differ significantly between the two groups. Eight of CoNS patients (73%) and fourteen of MRSA patients (52%) had significant association with diabetes mellitus. Conclusions Necrotizing fasciitis caused by CoNS is a surgical emergency and should be considered to be serious as that caused by MRSA. Diabetic patients with a history of abrasion injury or chronic ulcer should be cautioned about the risk of developing CoNS and MRSA necrotizing fasciitis.

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