Does anybody know?

[Derf]

Can anyone tell me the name of a staff infection that eats away at the tissues? I was on a call today that this same infection has affected the pt for 6 years. The pt started out by losing a toe, then another toe, until today the leg about the knee down is gone. Pt has had about 50 surgeries to date. The pt is no longer able to get vein access other than a port placed in.


I was wondering the name, the longevity of this, but most of all how contagious this can be. I was the driver on this run and did not have much pt contact, but would like to know the effects this could have. Thanks!!

 

[TKO]

Oooohhhh... sounds to me like Necrotizing Fasciitis. Been there, done that.

There appears to be a link between methicillin-resistant Staphylococcus aureus (MSRA) and Necrotizing Fasciitis.

I'll leave the rest to Google and those with more time and a better understanding of it.

 

[Ridryder911]

Oooohhhh... sounds to me like Necrotizing Fasciitis. Been there, done that.

There appears to be a link between methicillin-resistant Staphylococcus aureus (MSRA) and Necrotizing Fasciitis.

I'll leave the rest to Google and those with more time and a better understanding of it.

We have a WINNER !

Nasty, nasty stuff !

R/r 911

 

[TKO]

What do I win? If it's Necro-Fasc, I don't want it!

 

[disassociative]

Lord have mercy, MRSA and Endocarditis = Bad Ju Ju.

viridans streptococci, enterococci, stapholococcus aureus to name a few.

Get ready with the Vancomycin

 

[rgnoon]

Apparently necrotizing fasciitis is most often caused by group a strep. However, as disassociative alluded to, more and more cases are being attributed to resistant stapholococcus aureus...good 'ole mrsa.

"Lord have mercy....bad juju" - ditto.

 

[Rattletrap]

Lord have mercy, MRSA and Endocarditis = Bad Ju Ju.

viridans streptococci, enterococci, stapholococcus aureus to name a few.

Get ready with the Vancomycin

Then you got VRE. For the life of me at the moment I can't remember what the E stands for but Vancomycin does not touch it. We have a few patients in NH that have it.

 

[TKO]

I was wondering the name, the longevity of this, but most of all how contagious this can be. I was the driver on this run and did not have much pt contact, but would like to know the effects this could have. Thanks!!

Well, I hope you were using PPE to better isolate yourself from the pt. Years ago I had a pt with open wounds to the leg that turned out to be infected with N.F. I found out about it after the pt coded and my supervisor called me with the news. I thought he was joking but he wasn't. I had to be checked out and was given some monster-sized antibiotics. All was well that ends well, but for your sake, I hope you took all precautions and disinfected EVERYTHING in your bus afterwards.

 

[rgnoon]

Then you got VRE. For the life of me at the moment I can't remember what the E stands for but Vancomycin does not touch it. We have a few patients in NH that have it.

Vancomycin Resistant Enterococcus
Until reclasification, enterococcus was considered a Class D strep. DNA analysis verified that it is indeed of a seperate genus entirely. A really cool bacteria.

 

[BruceD]

Can anyone tell me the name of a staff infection that eats away at the tissues? I was on a call today that this same infection has affected the pt for 6 years. The pt started out by losing a toe, then another toe, until today the leg about the knee down is gone. Pt has had about 50 surgeries to date. The pt is no longer able to get vein access other than a port placed in.


I was wondering the name, the longevity of this, but most of all how contagious this can be. I was the driver on this run and did not have much pt contact, but would like to know the effects this could have. Thanks!!

Hey -

It's unlikely that your patient had the staph type necrotizing fasciitis. It is usually much more rapidly progressive (within hours), but thanks to the 'wonderful' pictures the media distributed in the '90s, it's the one most people think about. The mortality rate in staph NF was around 10% in the 90's. It's more likely that your patients had repeated re-infections while being immuno-compromised.

Other causes of Necrotizing fasciitis:

Grp A Strep - Also known as Strep pyogenes, this is the most common cause of NF, with a mortality rate approaching 20% (1). Incidentally, this is also the bug that causes strep throat, impetigo, and strep toxic shock syndrome (toxic shock like syndrome). This bacteria is pretty much everywhere.
Early Signs: Fever, severe pain, swelling, and redness around the wound site. (kinda general huh?)

Vibrio vulnificus - this little bacteria is picked up (normally) by those with (or getting) an open wound while either swimming in warm/tropical coastal waters or handling salt-water fish. It's harbored by copepods. Iron overload states (like hemochromatosis) appears to be a risk factor for this infection. (2)

Clostridium perfringens - This one is ubiquitous as well (all over the place), including residing in the human gut as normal flora. This is also the common cause of gas gangrene (myonecrosis) and can additionally produce a seriously nasty necrotizing intestinal disease. (3) This one can often be cultured from NF in IVDA. (4)

Other bacteria in the normal flora can also cause NF. Particularly, this is more common with diabetic patients, especially in areas of poor circulation and/or sites of injection.

To make you feel better:
The things that cause NF are all around us, all the time. In all that I read, immuno-compromised conditions (cancers, DM, transplant patients, etc) and skin/mucosal penetrations are almost always required (or deep wounds with the C. perfringens) to develop these conditions. (Some patients had apparently been infected through undetectable skin lacs).
Disinfection of your truck should be easily accomplished by the same procedures you follow after each patient. (You do wipe the cot down, right?)
(Be aware there is a hoax on the internet - something about bananas and NF - it is patently false.)

1) http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupastreptococcal_g.htm
2) Sherris Medical Microbiology 4th ed. p 378
3) Sherris Medical Microbiology 4th ed. p 316-317
4) National Institutes of health: http://gateway.nlm.nih.gov/MeetingAbstracts/102270104.html

Other sources:
- there is an NNFF dot org site - don't know anything about them, so didn't want to provide a 'real' link. They appear to be a good source of information and support.
- A google scholar search produces some solid results - be warned they often contain very disturbing images, don't let your kids in the room if you are looking!

Sorry if this was more information than you wanted, but I felt having it at your fingertips might make you feel a bit better.
tc
-B

 

[Derf]

Thank you for all the info! The name that she called it was mrsa sp? We were told she had just been tested positive for it again. I had never heard of it before. We used the same precautions as always BSI!! The cot was cleaned and disinfected as were all the equipment we used with the pt. But once again all the info really helped. Thanks

 

[BruceD]

Necrotizing fasciitis caused by Methicillin Resistant Staph aureus. A rarity... Not to make light of such a serious infection, but I wish I had been on the crew for that run.

It's increasing in incidence, unfortunately.

Take care.

-B

 

[DisasterMedTech]

Watch it...

MRSA is on the rise because physicians blast patients with anti-biotics for things that dont require them or that they dont work for and also patients that dont take all of their anti-biotics, thus producing "super bugs." I had a shift a few months ago where we had five MRSA positive patients in one day. Personally, I wear gown with gloves over the cuffs of the gloves, N95 mask and disposeable face shield if its available or your safety glasses if its not. In EMS and Disaster Medicine we are going to see alot more MRSA as time goes by so everyone should know how to deal with it. It wasnt even mentioned in my EMT class. So much for thorough-ness. :wacko:

 

[BruceD]

hehe, you left out:
Use of antibiotics in animal feeds
OTC antibiotics in 3rd world countries
Heavy metals leaking into ground water

All also contribute to rising resistance to anti-microbials.