Monomicrobial necrotizing fasciitis caused by coagulase-negative Staphylococci and methicillin-resistant Staphylococcus aureus

Coagulase-negative staphylococci (CoNS) have been reported to cause necrotizing fasciitis; however, there are some difficulties in differentiating the roles of CoNS infections as contaminants or pathogenic isolates. Methicillin-resistant S. aureus (MRSA) has emerged as the most common isolate to cause necrotizing fasciitis in the past decade. This study was to compare the clinical presentation and surgical outcome of CoNS and MRSA monomicrobial necrotizing fasciitis, and to assess the prevalence of CoNS and MRSA infection in diabetic patients. Necrotizing fasciitis caused by CoNS in 11 patients and that caused by MRSA in 27 patients was retrospectively reviewed. Demographic data, underlying diseases, laboratory results, and clinical outcome were analyzed for each patient in two groups. All patients underwent fasciotomy and received broad-spectrum antibiotic therapy. The mortality of MRSA group and CoNS group was 18.5 and 9%, respectively. Mortality, patient characteristics, clinical presentations, and laboratory data did not differ significantly between the two groups. Eight of CoNS patients (73%) and fourteen of MRSA patients (52%) had significant association with diabetes mellitus. Necrotizing fasciitis caused by CoNS is a surgical emergency and should be considered to be serious as that caused by MRSA. Diabetic patients with a history of abrasion injury or chronic ulcer should be cautioned about the risk of developing CoNS and MRSA necrotizing fasciitis.