Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles

Antibiotic Prophylaxis in Surgery—2005 and Beyond

TARGET AUDIENCE

Surgeons, pharmacists, and other physicians who prescribe prophylactic antibiotics.

LEARNING OBJECTIVES

After reading this article, the reader should be able to: Outline the attributes of antibiotics that are suitable for prophylaxis; review the activity and safety profiles of commonly-prescribed prophylactic antibiotics; and discuss the importance of proper administration as well as proper choice of an agent to minimize the risk of infection.

CME ACCREDITATION

The National Foundation for Infectious Diseases (NFID) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide Continuing Medical Education (CME) for physicians. NFID takes responsibility for the content, quality, and scientific integrity of this CME activity. NFID designates this CME activity for a maximum of one (1.0) category 1 credit toward the AMA Physician's Recognition Award. Physicians should only claim those hours of credit that he/she actually spent in the educational activity.

SUPPORT

This CME ctivity has been made possible by an unrestricted educational grant from Cubist Pharmcaeuticals, Inc.

DISCLOSURE

Dr. Barie serves as a consultant for Cubist Pharmaceuticals, Inc. Dr. Nichols serves on the surgery advisory board for Cubist Pharmaceuticals, Inc. Dr. Condon has no financial relationship to disclose.

CME INSTRUCTIONS

To receive CME credits after reading the entire publication, please go to the following website <www.nfid.org/cme/surgicalinfections2005> to complete the self-assessment examination and evaluation. Requests for credit must be received no later than six months following the publication date.

Rapidly progressive soft tissue infections

Skin and soft tissue infections are among the most common reasons for people to seek medical advice. They also represent one of the most common indications for antimicrobial therapy and account for approximately 7-10% of hospitalisations in North America. Although non-limb and non-life threatening infections may be treated on an out-patient basis with oral antibiotics, patients with more serious acute skin and soft tissue infections may require admission to hospital for management; this decision is especially true if the infection is rapidly progressive. We provide a concise overview of the differential diagnosis and approach to management of community-acquired rapidly progressive skin and soft tissue infections.

Necrotizing fasciitis during de novo minimal change nephrotic syndrome in a kidney transplant recipient

Skin infections and particularly necrotizing fasciitis (NF) represent a rare but serious complication after transplantation. Optimal management depends on prompt diagnosis with identification of the causative organisms to allow appropriate antibiotic therapy in association with surgical debridement. We report a case of a methicillin-resistant Staphylococcus aureus (MRSA) NF as the single pathogen in a renal transplant recipient, during the course of a de novo minimal-change nephrotic syndrome, treated with high-dose steroids. Antibiotic therapy together with surgical debridement and discontinuation of immunosuppressive treatment led to a complete recovery, despite persistence of the nephrotic syndrome. The development of de novo minimal-change nephrotic syndrome after renal allograft transplantation should alert physicians to the possibility of MRSA NF during an increase in the immunosuppressive regimen.