Incidence and clinical characteristics of methicillin-resistant Staphylococcus aureus necrotizing fasciitis in a large urban hospital

Background: Methicillin-resistant Staphylococcus aureus (MRSA) has become a prevalent health issue for soft-tissue infections. In severe soft-tissue infections such as necrotizing fasciitis, MRSA has been identified as an increasingly common pathogen. Herein, we report a 5-year experience of MRSA necrotizing fasciitis at a large urban hospital. Methods: All cases of necrotizing fasciitis between 2001 and 2006 were reviewed. All patients were taken for surgical debridement. MRSA patients were identified and compared with the non-MRSA patients to identify any clinical variables that impacted incidence or severity of disease. A P value of less than .05 was considered significant. Results: During the 5-year period, there were 74 cases of necrotizing fasciitis with a 39% prevalence of MRSA as the causative organism for the infection. The mean age of patients with MRSA fasciitis was 43 ± 3 years. There were no discernible social variables (eg, smoking, ethanol use, intravenous drug use) that predisposed patients to MRSA infection. The overall mortality rate was 15%, with no significant difference between groups. One hundred percent of MRSA specimens were susceptible to vancomycin or rifampin, 93% were susceptible to sulfamethoxazole/trimethoprim, and only 62% were susceptible to clindamycin. Conclusions: The incidence of MRSA fasciitis may be much higher than initially suspected and prompt MRSA-directed antibiotic therapy should be administered. Clinicians should maintain a high index of suspicion for this organism in necrotizing fasciitis.