From the Guidelines
The management of necrotizing fasciitis using the Leriche score involves immediate surgical debridement and broad-spectrum antibiotics, with the goal of reducing morbidity, mortality, and improving quality of life.
Key Considerations
- The Leriche score is not a widely recognized or established scoring system for necrotizing fasciitis, and its use is not supported by the provided evidence.
- The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is a more established tool for diagnosing necrotizing fasciitis, with a score of 8 or higher indicating a high risk of necrotizing fasciitis 1.
- The Fournier’s Gangrene Severity Index (FGSI) is a scoring system specifically designed for Fournier’s gangrene, with a score of 9 or higher indicating a high risk of mortality 1.
Treatment Approach
- Immediate surgical debridement of all necrotic tissue is essential for the treatment of necrotizing fasciitis, with the goal of achieving healthy tissue margins 1.
- Broad-spectrum antibiotics should be started empirically, typically including a combination of piperacillin-tazobactam or meropenem, plus vancomycin to cover both gram-negative and gram-positive organisms including MRSA 1.
- Antibiotic therapy should be adjusted based on culture results and continued for at least 14 days 1.
- Supportive care, including fluid resuscitation, vasopressors if needed, and intensive care monitoring, is crucial for patients with severe disease 1.
Adjunctive Therapies
- Hyperbaric oxygen therapy may be considered as an adjunctive treatment, but its effectiveness is not well established [@Example@].
- Nutritional support should be initiated early, with 25-30 kcal/kg/day and 1.5-2 g/kg/day of protein, to support wound healing and overall recovery [@Example@].
From the Research
Management and Treatment of Necrotizing Fasciitis
The management and treatment of necrotizing fasciitis can be guided by the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, which is a useful clinical determinant in the diagnosis and surgical treatment of patients with necrotizing fasciitis 2.
Leriche Score
However, it appears there is a confusion in the question as it mentions the "Leriche score" which is not found in the provided evidence. The correct term used in the studies is the "LRINEC score", not "Leriche score".
Diagnosis and Treatment
- The LRINEC score is based on laboratory tests routinely performed for the evaluation of severe soft tissue infections, including total white cell count, hemoglobin, sodium, glucose, serum creatinine, and C-reactive protein 3.
- A high LRINEC score is associated with a higher risk of mortality, especially in elderly patients, with a cardiac history, more than two comorbidities, or a lactate level greater than 1.7 mmol/L 4.
- Early diagnosis, simplified risk stratification, and on-time management are vital to achieve better outcomes in patients with necrotizing fasciitis 5.
- The treatment of necrotizing fasciitis involves aggressive surgical therapy, including debridement and drainage, as well as an interdisciplinary strategy of conservative therapy, and hyperbaric oxygen may be considered as a treatment adjunct in patients with necrotizing fasciitis if surgery and antibiotic treatment fail 6.
Prognostic Factors
- The LRINEC score can predict worse hospital outcomes in patients with necrotizing fasciitis and simply identify high-risk patients 5.
- Other prognostic factors for mortality in necrotizing fasciitis include age ≥ 60 years, cardiovascular disease, ≥ 2 comorbidities, and lactate level greater than 1.7 mmol/L 4.