Necrotizing Fasciitis – A Case Report of GBS Infection in a Previously Healthy Woman

Special Article – Surgery Case Reports

Austin J Surg. 2019; 6(16): 1204.

Necrotizing Fasciitis – A Case Report of GBS Infection in a Previously Healthy Woman

Kochan P1*, Rajca L2, Samet A3, Heczko PB1 and Brzychczy-Wloch M1

1Chair of Microbiology, Jagiellonian University Medical College, Poland

2Kociewskie Centrum Zdrowia, Starogard Gdanski, Poland

3Clinical Microbiology Laboratory, Clinical University Centre, Poland

*Corresponding author: Piotr Kochan, Chair of Microbiology, Jagiellonian University Medical College, 18 Czysta Street, 31-121 Cracow, Poland

Received: July 18, 2019; Accepted: August 08, 2019; Published: August 15, 2019


This article describes a case of necrotising fasciitis following a procedure of total hysterectomy caused by group B streptococcus in a previously healthy 50 year-old female patient. The patient was readmitted to the hospital in the 7th post-surgical day with a necrotic surgical site infection. Microbiological cultures were collected and Streptococcus agalactiae isolate was further characterized by molecular techniques. Besides of the invasive infection, the patient also developed an abscess in the lumbar region. The treatment consisted of surgical debridement, incision and drainage, a combination of antibiotic courses and hyperbaric therapy. The patient made a full recovery. This was her second episode of postsurgical complications, with the first one occurring in 2011. This is possibly the first report of necrotizing fasciitis in a previously healthy patient caused by GBS in Poland. We would like to open a discussion whether GBS screening before gynaecological procedures should be a standard, since invasive GBS infections play a role not only in Europe but also in the USA.

Keywords: Streptococcus agalactiae (GBS); Invasive infection; Necrotizing fasciitis; Multilocus sequence typing (MLST)


Necrotising fasciitis is a severe, invasive and life-threatening bacterial infection. Such invasive infections may occur as a complication of surgical procedures or as posttraumatic infections and often involve patients with underlying chronic medical conditions including diabetes, immunocompromise, obesity, alcoholism, peripheral vascular disease cancer, intravenous drug use and malignancies. There are 6 general types of necrotising fasciitis as per etiological agents: (i) caused by streptococci (mainly group A); (ii) caused by Clostridium sp.; (iii) caused mixed aerobic and anaerobic microbes; (iv) caused by CA-MRSA; (v) caused by K. pneumoniae and (vi) Vibrio vulnificus [1,2]. The infection described here could be characterized as (i) and (iii), as above.

Streptococcus agalactiae, also referred to as Lancefield group B Streptococcus (GBS), is an important pathogen in neonates and adults with predisposing conditions in the USA and Europe [3,4]. GBS cause important infections in neonates, encompassing respiratory tract infections, meningitis and sepsis, especially in prematurely born. It colonises the genitourinary and lower gastrointestinal tract of 10 to 40% of women. Even 1/3 of pregnant women may be colonized with group B streptococcus [4]. S. agalactiae is a genetically diverse organism. Therefore, nowadays, a combination of several molecular typing methods should be considered to gain a better understanding of the pathogenesis and epidemiology of GBS isolates [5-9]. In many countries, there are guidelines for 3rd trimester GBS vaginal screeening during pregnancy and intrapartum antibiotic prophylaxis [4].

Patient Description

Female patient, aged 50, was admitted to the Department of Gynaecology in Kociewskie Centrum Zdrowia in Starogard Gdanski, Poland, 7 days post surgery owing to Surgical Site Infection (SSI). She underwent total hysterectomy due to a left ovarian tumour on 28.11.2012. Upon admission her chief complaint was elevated body temperature of 38°C for two days, oedema and erythema around the surgical site. Looking back into the medical history, her immediate perioperative course showed no complications. The first few days after surgery showed no complications either. The patient discharged herself against medical advice on the 3rd day post-surgery.

On readmission (05.12.2012), the patient presented in moderately bad general status, with body temperature of 38°C, BP 80/40 mmHg but her cardiovascular and respiratory status was stable. Proximity of the surgical site was oedematous, erythematous and warm with grey margins. After removal of stiches, wound dehiscence occurred along the whole length of the surgical site. Large necrotic changes were observed which extended to the subcutaneous tissue and fascia, and a lot of dark-coloured foul-smelling fluid was present (Figures 1 & 2). In the region of the left margin of the surgical site there was inflammatory infiltration penetrating to the wing of ilium. Microbiological material was collected by swabbing and aspiration from the wound. A semi quantitative scale was used to describe the initially cultured organisms (05.12.2012), for details please see (Table 1). There were more samples collected along the course of the infection and the wound aspirates on 06.12.2012 and 07.12.2012 did not show the growth of GBS anymore. Also the control cultures (14.12.2012) from the throat, nose, rectum, vagina, inguinal region, axilla were negative for GBS. The follow-up swabs collected on 14, 21, 24, 30 December 2012 as well as 6 January 2013 were also negative for GBS.