Molecular characterization of methicillin-resistant Staphylococcus aureus from a fatal case of necrotizing fasciitis in an extremely low-birth-weight infant

• Published in: Clinical microbiology and infection Vol. 16; no. 3; pp. 289 - 292
• Main Authors: Orii, K.O., Iwao, Y., Higuchi, W., Takano, T., Yamamoto, T.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Elsevier Ltd 01.03.2010; Blackwell Publishing Ltd; Wiley-Blackwell; Elsevier Limited
• Subjects: Bacterial diseases; Bacterial diseases of the nervous system. Bacterial myositis; Bacterial Proteins - genetics; Bacterial Typing Techniques; Bacteriology; Biological and medical sciences; Cross Infection - microbiology; Data processing; Diseases of mother, fetus and pregnancy; Disseminated intravascular coagulation; Disseminated Intravascular Coagulation - microbiology; DNA Fingerprinting; DNA, Bacterial - chemistry; DNA, Bacterial - genetics; Drug resistance; Enterotoxins - genetics; Extremely low-birth-weight infant; Fasciitis; Fasciitis, Necrotizing - complications; Fasciitis, Necrotizing - microbiology; Fatal Outcome; Genes; Genotype; Geriatrics; Gynecology. Andrology. Obstetrics; Human bacterial diseases; Humans; Infant, Extremely Low Birth Weight; Infant, Newborn; Infants; Infection; Infectious diseases; leukocidin; Low-birth-weight; Medical sciences; methicillin-resistant Staphylococcus aureus; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Molecular Sequence Data; Necrotizing fasciitis; Panton–Valentine; Panton–Valentine leukocidin; Pregnancy. Fetus. Placenta; Sepsis; Sepsis - microbiology; Sequence Analysis, DNA; staphylococcal enterotoxin; Staphylococcal Infections - complications; Staphylococcal Infections - microbiology; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcal Protein A - genetics; Staphylococcus aureus; Staphylococcus infections; virulence factors; Virulence Factors - genetics; staphylococcal enterotoxin; methicillin-resistant Staphylococcus aureus; Extremely low-birth-weight infant; Panton–Valentine; leukocidin; necrotizing fasciitis; Premature; Skin disease; Pregnancy disorders; Infant; Very low birthweight; Panton-Valentine leukocidin; Necrotizing fasciitis; Bacteria; Micrococcales; Micrococcaceae; Staphylococcus aureus; Human; Connective tissue disease; Cytokine; methicillin-resistant Staphylococcus oureus; Fatal course; Infection; Toxin; Newborn diseases; Prematurity; Bacteriosis; Enterotoxin; Staphylococcal infection
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1111/j.1469-0691.2009.02806.x

Necrotizing fasciitis due to methicillin-resistant Staphylococcus aureus (MRSA) is an uncommon but life-threatening infection, and has mainly been reported as occurring in adults and the elderly. Recently, infant cases involving Panton–Valentine leukocidin (PVL)-positive community-acquired MRSA have been noted. Here, a case of fatal necrotizing fasciitis with sepsis and disseminated intravascular coagulation in an extremely low-birthweight infant is described. The causative agent was the hospital-acquired MRSA New York/Japan clone carrying the spa variant gene and nine staphylococcal enterotoxin (SE) genes. These data suggest that a high-level combination of SEs and other virulence factors, but not PVL, could contribute to the pathogenesis of fatal necrotizing fasciitis.