Compartment syndrome as a novel complication of extended spectrum beta lactamase Escherichia coli necrotising soft tissue infection – A case report. (October 2022)

• Record Type: Journal Article
• Authors: Gibson, Damien; Chow, Oliver; Seth, Ishith; Siu, Adrian Hang Yue; Kwei, Johnny
• Is Part Of: International journal of surgery case reports. Volume 99(2022)
• Publication Date: 2022-10
• Subjects: NSTI necrotising soft tissue infections -- ESBL extended spectrum beta lactamase -- MRSA methicillin-resistant Staphylococcus aureus -- IVIG intravenous immunoglobulin -- HBOT hyperbaric oxygen therapy; Soft tissue infections -- Compartment syndromes -- Fasciitis -- Necrotising -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2022.107574
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction and importance: Necrotising soft tissue infections (NSTI) encompass a group of destructive soft tissue disease processes which can involve skin, subcutaneous tissue, fascia and or muscle, associated with rapid spread along tissue planes and mortality. Clinical presentations include progressive pain, suppuration/necrosis and systemic toxicity with haemodynamic instability. While diagnosis is based on clinical findings it can be augmented with imaging. Treatment is typically in the form of resuscitation, immediate administration of broad spectrum intravenous antibiotics and urgent source control through radical surgical debridement. Case presentation: An 82-year-old man presented with left forearm/hand pain and fevers in the context of immunocompromise. Examination found tense swelling of the left volar and dorsal forearm and hand, absent distal pulses with pain and paraesthesia over both surfaces. He underwent surgical debridement with fasciotomy and remained in intensive care with blood cultures revealing ESBL E. coli . Clinical discussion: Compartment syndrome is a rare complication of NSTI and its clinical presentation can obscure early diagnosis. ESBL E. coli is an uncommon pathogen to cause monomicrobial infection and must be accounted for when considering broad spectrum empirical antibiotic cover. Conclusion: Review of this case and the literature show a rare presentation of NSTI and highlights the importance of early diagnosis based on even a small index of suspicion. It also shows the key significance rationalisation of antibiotics as soon as practicable, given that even broad spectrum empirical cover can be inappropriate in the context of novel microorganisms, particularly in high risk patients. Highlights: First recorded case of monomicrobial ESBL E. coli compartment syndrome ESBL E. coli NSTI is rare and not covered by many empirical antimicrobial guidelines. Compartment syndrome secondary to NSTI is uncommon and associated with streptococci. Early recognition and prompt management are essential to prognosis.