meropenem and Fasciitis--Necrotizing

Topics: Abdomen; Adult; Anti-Bacterial Agents; Clindamycin; Coinfection; Debridement; Diabetes Mellitus, Type 2; Fasciitis, Necrotizing; Female; Fluid Therapy; Humans; Meropenem; Methicillin-Resistant Staphylococcus aureus; Obesity; Renal Insufficiency, Chronic; Resuscitation; Staphylococcal Infections; Streptococcal Infections; Streptococcus pyogenes; Vancomycin

Necrotizing fasciitis (NF) is defined as a rare, rapidly progressive, and highly lethal skin infection characterized by necrosis of the fascia and subcutaneous tissue.. The present study aims to discuss the case of a 35-year-old man who developed NF following a routine sterile right distal radius bone plate removal surgery.. The patient was suspected of NF based on his clinical manifestations, laboratory tests, and imaging results. The diagnosis of NF was confirmed by histological examinations.. Serial prompt and extensive debridement was performed during the rapid and aggressive extension of the skin infection, together with antibiotics and supportive treatments.. The condition of the patient finally improved on the sixth day of disease progression. Skin grafting of his right forearm wound was performed successfully 2 months after the admission.. NF can occur during the perioperative period for routine clean radius plate removal operation in patients with no risk factor for NF. The objective is to remind the physicians to stay aware of this disease, especially its early clinical signs and symptoms. Urgent subsequent treatment, including surgical debridement, antibiotic therapy, and supporting management, is the key to ensure the survival and better prognosis of patients.

Topics: Adult; Anti-Bacterial Agents; Bone Plates; Cefonicid; Debridement; Decompression, Surgical; Device Removal; Disease Progression; Fasciitis, Necrotizing; Forearm; Fracture Fixation; Humans; Magnetic Resonance Imaging; Male; Meropenem; Radius Fractures; Reoperation; Streptococcus pyogenes; Thienamycins; Tomography, X-Ray Computed; Treatment Outcome; Vancomycin

Necrotizing fasciitis is an uncommon soft-tissue infection that involves the superficial fascia, subcutaneous fat, and deep fascia. Herein, we report the first case of Enterobacter cloacae-related necrotizing fasciitis after peritoneal dialysis in delayed graft function.. A 58-year-old man, who was a hepatitis B-viral carrier and had atrial fibrillation, received cadaveric renal transplantation with peritoneal dialysis and encountered delayed graft function. On postoperative day 5, we tried hemodialysis via the right jugular dialysis catheter. However, he was unable to endure the hemodynamic changes during hemodialysis, showing rapid ventricular rhythm on electrocardiography. On postoperative day 7, we changed to peritoneal dialysis. However, he presented with fever and pain on his left flank and lower extremity. His white blood cell count and C-reactive protein levels were suddenly elevated. According to the abdomen computed tomography scan, there were subcutaneous fluid and air in the left flank and anterolateral pelvic wall. We performed peritoneal dialysis catheter removal, debridement, and drainage of the left external oblique muscle fascia. In a culture, Enterobacter cloacae was identified. After receiving meropenem for 2 months, his wound healed and delayed graft function was recovered.. Peritoneal dialysis of delayed graft function seems to be effective in reducing the incidence and severity of delayed recovery of renal function after renal transplantation in some reports. However, it is necessary to be cautious when dealing with a rapidly developing and life-threatening soft-tissue infection, such as necrotizing fasciitis. To reduce mortality rates, early diagnosis, recurrent surgical debridement, and aggressive therapy are mandatory.

Topics: Anti-Bacterial Agents; Delayed Graft Function; Enterobacter cloacae; Enterobacteriaceae Infections; Fasciitis, Necrotizing; Humans; Kidney Transplantation; Male; Meropenem; Middle Aged; Peritoneal Dialysis; Thienamycins

Topics: Administration, Intravenous; Aged; Amputation, Surgical; Anti-Bacterial Agents; Bacterial Infections; Clindamycin; Debridement; Escherichia coli; Fasciitis, Necrotizing; Female; Humans; Immunosuppressive Agents; Leg; Lupus Erythematosus, Systemic; Magnetic Resonance Imaging; Meropenem; Spondylitis; Staphylococcus epidermidis; Staphylococcus hominis; Thienamycins; Tomography, X-Ray Computed; Treatment Outcome

Serratia marcescens is a Gram-negative bacillus belonging to the Enterobacteriaceae family. Cutaneous infection with Serratia is rare, and usually occurs in immunocompromised individuals. Primary cutaneous infections are uncommon, but they are typically severe and are associated with significant morbidity and mortality. The pathogenetic factors leading to S. marcescens infection are not fully understood, but contributing virulence factors include proteases, secreted exotoxins, and the formation of biofilm. We report a case of cellulitis occurring in a splenectomized patient, which led to multiple wound debridements and a transmetatarsal amputation. This dramatic case led us to review the published literature on soft tissue infections caused by S. marcescens.

Topics: Aged; Amputation, Surgical; Anti-Bacterial Agents; Biopsy; Cellulitis; Ciprofloxacin; Debridement; Fasciitis, Necrotizing; Foot Dermatoses; Humans; Male; Meropenem; Serratia Infections; Serratia marcescens; Skin Diseases, Vesiculobullous; Splenectomy; Thienamycins; Treatment Outcome

Necrotizing fasciitis is a severe polybacterial infection characterized by necrosis of the fascia and adjacent soft tissues with rapid expansion of the infection along the fascial planes. It is a rare and potentially fatal entity in the head and neck region. We present 2 patients with head and neck cancers who developed necrotizing fasciitis during the postoperative period.

Topics: Acinetobacter baumannii; Adult; Colistin; Fasciitis, Necrotizing; Head and Neck Neoplasms; Humans; Imipenem; Klebsiella pneumoniae; Male; Meropenem; Middle Aged; Minocycline; Postoperative Period; Pseudomonas aeruginosa; Thienamycins; Tigecycline

A 70-years of age, male patient with underlying type 2 diabetes mellitus, hypertension, dyslipidemia and ischemic heart disease had undergone continuous ambulatory peritoneal dialysis (CAPD)for 3 years without any episodes of peritonitis. He was diagnosed with necrotizing fasciitis and later developed peritonitis after receiving a laceration from an aquatic injury suffered during the flood disaster of 2011. The blood culture, necrotic tissue and the clear dialysate collected upon admission had shown Aeromonas sobria. The route of peritonitis may be from the hematogenous spread of A. sobria resulting in necrotizing fasciitis. A. sobria should be considered as the pathogen of peritonitis in PD patients who have history of wounds from contaminated water. We suggest that the PD patients who present with septicemia and did not meet the criteria for peritonitis, the initial dialysate effluent should be sent for culture. The benefit of this is to allow early recognition and treatment of peritonitis.

Topics: Aeromonas; Aged; Anti-Bacterial Agents; Ciprofloxacin; Diagnosis, Differential; Fasciitis, Necrotizing; Humans; Male; Meropenem; Peritoneal Dialysis; Peritonitis; Thailand; Thienamycins; Treatment Outcome

To describe a case of severe cellulitis, successfully treated with high-dose daptomycin plus continuous infusion meropenem, in a patient with morbid obesity and renal failure, in whom drug exposure over time was optimized by means of real-time therapeutic drug monitoring (TDM).. A 63-year-old man with morbid obesity (body mass index 81.6 kg/m²) and renal failure was admitted to the emergency department because of severe cellulitis. The patient had an admission Laboratory Risk Indicator for Necrotizing Fasciitis score of 9, and broad-spectrum antimicrobial therapy with daptomycin and meropenem was started. Because of rapidly changing renal function, dosage adjustments were guided by an intensive program of TDM (daptomycin ranging from 1200 mg every 48 hours over 30 minutes to 1200 mg every 36 hours over 30 minutes; meropenem ranging from 0.25 g every 8 hours over 6 hours to 500 mg every 4 hours by continuous infusion). Clinical response was observed within 72 hours. However, a sudden increase of serum creatine kinase (SCK) raised questions about the need for discontinuation of daptomycin. The drug concentrations were not toxic; therefore, we decided to continue therapy. Significant clinical improvement, with SCK normalization, was observed within a few days. Antimicrobial therapy was switched on day 29 to amoxicillin/clavulanate plus levofloxacin, and then discontinued at discharge on day 53.. High-dose daptomycin plus continuous infusion meropenem may ensure adequate empiric antimicrobial coverage in patients with possible early necrotizing fasciitis. However, in patients with morbid obesity and changing renal function, significant challenges may arise because of the hydrophilic nature of these drugs and the inaccuracy of standard methods of estimating renal function.. Real-time TDM may represent an invaluable approach in optimizing drug exposure with high-dose daptomycin plus continuous infusion meropenem in patients with severe cellulitis, morbid obesity, and changing renal function.

Topics: Anti-Bacterial Agents; Cellulitis; Creatine Kinase; Daptomycin; Drug Monitoring; Drug Therapy, Combination; Fasciitis, Necrotizing; Humans; Male; Meropenem; Middle Aged; Obesity, Morbid; Renal Insufficiency; Severity of Illness Index; Thienamycins; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Diagnosis, Differential; Escherichia coli; Fasciitis, Necrotizing; Fever; Humans; Male; Meropenem; Pain; Penicillins; Thienamycins

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Fasciitis, Necrotizing; Female; Humans; Leg; Meropenem; Pemphigoid, Bullous; Thienamycins; Treatment Outcome; Ultrasonography; Vancomycin