Abstract Introduction Animal bites can introduce a variety of pathogens and prompt treatment with antibiotics should be considered. Failure to undergo treatment increases the risk of infections, including necrotizing soft tissue infections (NSTIs), which can progress rapidly. The mortality of NSTIs is high, and swift intervention with IV antibiotics and surgical debridement is essential. Case Report We present a 59-year-old female with a history of poorly controlled type II diabetes, hyperlipidemia, and myocardial infarction who presented to an outside hospital with altered mental status following a cat bite five days prior. On exam, her right arm had hemolytic wall bullae with tissue sloughing. Initial labs revealed a WBC 33,300 mcL, creatinine 3.29 mg/dL, BUN 61 mg/dL, lactic acid 11.3 mmol/L, and pH 7.01. She was started on vancomycin, clindamycin, and piperacillin/tazobactam. CT head, thorax, abdomen, and pelvis did not reveal a source of infection, and CT of the right arm indicated forearm subcutaneous edema, but no drainable fluid collection, abscess, foreign body, or air. Shortly after presenting, she suffered a cardiac arrest, but was successfully resuscitated. She was admitted to the ICU due to increasing pressor requirements, mechanical ventilation, and renal replacement therapy. The patient’s blood cultures grew out Streptococcus pyogenes. The patient was transferred to our facility for surgical management, as this was unavailable at the outside facility. Upon arrival, the patient was taken to the OR and, after multilevel exploration in an attempt at limb salvage, underwent open proximal trans-humoral amputation for source control. The following day, she returned to the OR. Progression of NSTI was noted and an open right shoulder disarticulation was performed. Her wound gram stain was positive for gram-positive cocci, but repeat wound culture and blood cultures were negative. Her hospitalization was prolonged by ventilator-associated pneumonia, PEG tube placement, and herpes simplex virus, but her mental status and metabolic dysfunction overall improved over the course of her 56-day hospitalization and she was discharged in stable condition. Discussion NSTIs require prompt surgical debridement. Antibiotics and other resuscitation measures are an important adjunct to this. Radiographic imaging can be helpful, but this should not delay surgical interventions, especially for patients with comorbidities such as diabetes, cardiovascular disease, obesity, and immunosuppression. Delay in either presentation and/or surgical intervention can lead to increased morbidity and mortality. When considering infections from cats or dogs, antibiotic coverage should consider skin flora and unique salivary organisms including Pasteurella, Moraxella, and Neisseria. This abstract is funded by: None
Hagen et al. (2026) studied this question.