Cases of necrotizing fasciitis caused by community-acquired methicillin-resistant Staphylococcus aureus are on the rise, Loren G. Miller, M.D., of Harbor-UCLA Medical Center, Los Angeles, and colleagues reported.
Of 843 patients whose wound cultures grew MRSA over a 15-month period in 2003-2004, 14 had necrotizing fasciitis, necrotizing myositis, or both (N. Engl. J. Med. 2005;352:1445-53).
None of the 14 patients died, but all had one or more serious complications. Combined surgical and medical treatment was provided; all MRSA isolates showed in vitro susceptibility to clindamycin, trimethoprim-sulfamethoxazole, and rifampin.
S. aureus has been a rare cause of necrotizing fasciitis, but cases caused by community-acquired MRSA represent an emerging clinical syndrome. Empirical treatment in suspected cases, particularly where MRSA is endemic, is necessary regardless of the presence of clinical risk factors, and should include antibiotics active against the locally circulating strains, they said.
This represents a major departure from currently recommended treatment for necrotizing fasciitis, the authors added.
COPYRIGHT 2005 International Medical News Group
COPYRIGHT 2005 Gale Group
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