Necrotizing fasciitis: the role of Staphylococcus epidermidis, immune status and intravascular coagulation

An 83 year old Caucasian woman with necrotizing fasciitis (NF) of the right hand is described. Staphylococcus epidermidis was the only organism cultured. Serology failed to demonstrate Streptococcus pyogenes, the common pathogen of NF. Despite antibiotic therapy, gangrene supervened, necessitating digital amputation. Staphylococcus epidermidis is usually non-pathogenic, but review of the literature indicates that it is relatively commonly found with other pathogens in NF. Accordingly, studies of immune status were undertaken. Apart from reduced myeloperoxidase production (30-50% of normal levels), all humoral, cell-mediated and neutrophil function tests were normal. This is the first report of Staphylococcus epidermidis as the sole isolate in NF and also the only study of immune status of NF patients. It is concluded that a non-virulent organism (e.g. Staphylococcus epidermidis) may be pathogenic in the face of advanced age alone. Elevated fibrin degradation productions were also demonstrated in the patient, consistent with lysis of localized intravascular thrombus. The role of anticoagulation in NF is discussed.