Neonatal necrotizing fasciitis and fungal infections in preterm infants

Abstract

Necrotizing fasciitis (NF) in premature infants is a rare, yet life-threatening, soft tissue infection. We report four cases of NF that were encountered over a seven-year period. The onset of the disease was between four and twelve days of age. Predisposing factors were omphalitis in two infants and intestinal perforation in the other two infants, one of whom had necrotizing enterocolitis. Surgical biopsies from the affected sites showed mucormycosis in one infant and bipolaris fungi in another. One of these infants was treated with antifungal therapy in addition to broad spectrum antibiotics. This infant survived, even without surgical intervention while the other three died. We conclude that intestinal perforation and omphalitis are important predisposing factors of NF in premature infants. Fungal infection should be considered as one of the possible causes of NF in preterm infants. Early initiation of antifungal therapy, in addition to broad spectrum antibiotics, is justifiable in this disease entity.