Necrotizing fasciitis in a medical center in northern Taiwan: emergence of methicillin-resistant Staphylococcus aureus in the community.

Necrotizing fasciitis (NF) is a rapidly progressive life-threatening infection. It is located in the deep fascia, with secondary necrosis of the subcutaneous tissues requiring urgent surgical and medical therapy. Staphylococcus aureus is, historically, a very uncommon cause of NF, but we have recently noted an increasing number of these infections being caused by community-acquired methicillin-resistant S. aureus (CA-MRSA). The medical records of 53 patients diagnosed with NF between January 2001 and December 2005 were reviewed. A standardized instrument was used to abstract information from the medical records of each patient. S. aureus monomicrobial infection accounted for 37.7% (20/53) of the causal organisms noted. Of the 20 strains of S. aureus, 8 were methicillin-sensitive S. aureus and 12 were MRSA. In the 12 patients with MRSA infection, 7 had CA-MRSA. All patients with NF caused by CA-MRSA had no serious coexisting conditions or risk factors. All CA-MRSA isolates were susceptible to ciprofloxacin, trimethoprim-sulfamethoxazole, and vancomycin in vitro. All were cured after surgical intervention and medical treatment. For patients with severe invasive NF caused by CA-MRSA, glycopeptides may be prescribed as an empirical treatment until susceptibility results. The prognosis of NF caused by CA-MRSA was good after adequate surgical and antimicrobial treatment.