Pediatric necrotizing soft tissue infection: unveiling a rare complication of routine procedures - peripheral venous catheter insertion

Necrotizing soft-tissue infection (NSTI) is a rare yet potentially fatal condition, particularly in pediatric patients. We report the first known case of a previously healthy 1-year and 7-month-old boy who developed methicillin-resistant Staphylococcus aureus (MRSA) NSTI following peripheral venous catheter (PVC) insertion. The patient developed swelling and erythema at the PVC site. Contrast-enhanced computed tomography (CT) confirmed diffuse fascial inflammation consistent with NSTI, which guided the urgent decision for surgical intervention. Aggressive management with vancomycin, meropenem, and clindamycin, along with emergent, tissue-sparing surgical debridement, was initiated. The patient recovered uneventfully after 11 days, with minimal scarring and normal range of motion at 3-month follow-up. This case highlights a rare but serious complication of PVC insertion and emphasizes the need for vigilance in distinguishing between infectious and non-infectious PVC-related complications in children. The challenges in routine replacement practices, skin preparation protocols, and monitoring underscore the need for continuous improvement in clinical practices. Importantly, this case illustrates how imaging can play a decisive role in early diagnosis and surgical planning. The tissue-sparing debridement approach adopted represents a strategic departure from historical aggressive methods, aiming to preserve viable tissue while achieving infection control. We propose incorporating vigilant monitoring, optimal nurse-to-patient ratios, and pediatric-specific protocols to enhance early detection and reduce morbidity associated with NSTI. Infectious diseases consultation was involved in guiding antibiotic de-escalation, highlighting the importance of balancing early broad-spectrum coverage with antimicrobial stewardship.