Necrotizing fasciitis due to penicillin-resistant Streptococcus pneumoniae: Case report and review of the literature

Necrotizing fasciitis (NF) is a life-threatening infection involving rapid necrosis of subcutaneous and fascial tissues. Streptococcus pneumoniae (SPN ) soft tissue infection is exceedingly uncommon, reported primarily in pati ents with immunosuppression or other underlying conditions. We report a cas e of NF and septic shock in a healthy 32-year-old man, whose only predispos ing factor was antecedent blunt trauma. Pathological examination and cultur e of the extensive-tissue debridement were positive only for SPN. The serot ype 9V isolate was penicillin (PCN)-resistant (MIC=2.0), and closely-relate d by pulse field gel electrophoresis and multilocus fingerprinting to clone France 9V-3, an important genetic reservoir for increasing PCN-resistance worldwide. This unique case has implications for our pathogenic understandi ng and empiric management of NT. (C) 2001 The British Infection Society.