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Abstract

We agree with the comment made by Aronoff et al that type I necrotizing fasciitis episodes are polymicrobial. In fact, we mentioned in our case report that Type I necrotizing fasciitis is a type of mixed infection, usually involving anaerobic bacteria (including Clostridium species) and streptococci other than Lancefield serogroup A.1Fragoulis K.N. Christodoulou C. Falagas M.E. Pain and a purple lesion.Am J Med. 2006; 119: 835-836Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar In addition, we agree with their comment regarding the empirical antimicrobial treatment of patients with necrotizing fasciitis, specifically that such treatment should be directed against a broad spectrum of microorganisms, covering both aerobic and anaerobic pathogens. Following this principle, our patient received broad-spectrum antimicrobial treatment, including meropenem. Also, data regarding the evolving epidemic of community-acquired methicillin resistant Staphylococcus aureus (MRSA) infections in patients in various parts of the world combined with our own previous experience with such infections2Michalopoulos A. Falagas M.E. Multi-systemic methicillin resistant Staphylococcus aureus (MRSA) community-acquired infection.Med Sci Monit. 2006; 12: CS39-CS43PubMed Google Scholar made us include linezolid in the initially administered empirical antimicrobial regimen when the diagnosis of necrotizing fasciitis was entertained. Finally, we agree with Aronoff et al that clindamycin is an important addition to penicillin for the treatment of patients with clostridial necrotizing fasciitis. We have been recommending3Falagas M.E. Gorbach S.L. Clindamycin and metronidazole.Med Clin North Am. 1995; 79: 845-867PubMed Scopus (42) Google Scholar the use of the combination of these antibiotics for patients with clostridial necrotizing fasciitis, because there also are supportive experimental data regarding Clostridium perfingens infections. Comments Regarding “Pain and a Purple Lesion”The American Journal of MedicineVol. 120Issue 11PreviewThe recent case report of Clostridium septicum necrotizing fasciitis (NF) published by Fragoulis et al1 highlighted a number of important aspects of the clinical presentation, diagnosis, and treatment of NF, but several comments made by the authors deserve clarification. They correctly note that there are 2 broad categories of NF divided according to the microorganisms cultured from the involved tissues or bloodstream.2 Although Fragoulis et al suggest that type I NF involves anaerobic bacteria or non-Lancefield group A streptococci, the common definition is broader. Full-Text PDF