Cheng Nai-Chen, Wang Jann-Tay, Chang Shan-Chwen, Tai Hao-Chih, Tang Yueh-Bih
Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
Ann Plast Surg. 2011 Dec;67(6):632-6. doi: 10.1097/SAP.0b013e31820b372b.
Staphylococcus aureus is an uncommon causative agent of monomicrobial necrotizing fasciitis, but we have noted several cases over the years. The patients treated for necrotizing fasciitis between January 1998 and December 2008 in our institution were identified, and their medical records were reviewed. Of 105 necrotizing fasciitis cases during the study period, 18 were caused by monomicrobial S. aureus infection (17%). The median age was 62 years (range, 12-81 years). Among this cohort, 10 patients had coexisting medical conditions or risk factors, including diabetes and hypertension. Lower limbs and upper limbs are the most commonly involved sites. Among the bacterial isolates from these cases, 8 were methicillin-sensitive S. aureus (MSSA) and 10 were methicillin-resistant S. aureus (MRSA). One patient died in the MSSA group, and 5 patients died in the MRSA group. The mortality rate and other clinical characteristics were not significantly different between the 2 groups. However, all MRSA necrotizing fasciitis developed after the year 2000, and it was significantly different from MSSA necrotizing fasciitis that predominantly took place before the year 2000. In conclusion, S. aureus is an important pathogen of monomicrobial necrotizing fasciitis, and MRSA has emerged as the predominant causative agent in recent years. Therefore, MRSA-directed antibiotic therapy should be considered when treating patients suspected with necrotizing fasciitis in endemic areas.
金黄色葡萄球菌是单微生物坏死性筋膜炎的一种罕见病原体，但多年来我们已注意到数例。我们确定了1998年1月至2008年12月在我院接受坏死性筋膜炎治疗的患者，并对其病历进行了回顾。在研究期间的105例坏死性筋膜炎病例中，18例由单微生物金黄色葡萄球菌感染引起（17%）。中位年龄为62岁（范围12 - 81岁）。在这一队列中，10例患者有并存的疾病或危险因素，包括糖尿病和高血压。下肢和上肢是最常受累的部位。在这些病例的细菌分离株中，8株为甲氧西林敏感金黄色葡萄球菌（MSSA），10株为耐甲氧西林金黄色葡萄球菌（MRSA）。MSSA组有1例患者死亡，MRSA组有5例患者死亡。两组之间的死亡率和其他临床特征无显著差异。然而，所有MRSA坏死性筋膜炎均在2000年后发病，与主要发生在2000年前的MSSA坏死性筋膜炎有显著差异。总之，金黄色葡萄球菌是单微生物坏死性筋膜炎的重要病原体，近年来MRSA已成为主要病原体。因此，在流行地区治疗疑似坏死性筋膜炎的患者时应考虑使用针对MRSA的抗生素治疗。
