From the Guidelines
Necrotizing fasciitis is a severe bacterial infection that requires immediate medical attention, and treatment typically involves aggressive surgical debridement, broad-spectrum intravenous antibiotics, and supportive care. The symptoms of necrotizing fasciitis include severe pain that seems disproportionate to the visible wound, swelling and redness that spreads quickly, skin that feels warm and appears shiny, fever, fatigue, and dizziness, as well as blisters filled with dark fluid, black areas of dead tissue, and eventually symptoms of toxic shock including confusion and organ failure 1. Some key features that suggest involvement of deeper tissues and possible necrotizing fasciitis include severe pain, failure to respond to initial antibiotic therapy, a hard and wooden feel of the subcutaneous tissue, systemic toxicity, edema or tenderness beyond the visible skin involvement, crepitus indicating gas in the tissues, bullous lesions, and skin necrosis or ecchymoses 1. Treatment should be initiated promptly, with surgical intervention being the primary therapeutic modality, and empiric antibiotic treatment should be broad, covering both aerobes and anaerobes, such as vancomycin or linezolid plus piperacillin-tazobactam or a carbapenem, or ceftriaxone and metronidazole 1. Initial antibiotic therapy often includes combinations like piperacillin-tazobactam (3.375g IV every 6 hours), vancomycin (15-20 mg/kg IV every 8-12 hours), and clindamycin (600-900mg IV every 8 hours) to cover various potential pathogens until cultures identify the specific bacteria 1. Multiple surgeries are often necessary, and hyperbaric oxygen therapy may be used as an adjunctive treatment in some cases, with supportive measures including intravenous fluids, pain management, and sometimes intensive care for organ support 1. The mortality rate remains high despite treatment, which is why early recognition and immediate medical intervention are crucial for survival.
From the Research
Symptoms of Necrotizing Fasciitis
- Necrotizing fasciitis (NF) is a serious infection of skin and soft tissues that rapidly progresses along the deep fascia 2
- It becomes a fatal soft tissue infection with high mortality rate if treatment is delayed 2
- The infection can cause symptoms such as skin necrosis, pulse rate >130/min, and systolic BP <90 mmHg 2
Treatment of Necrotizing Fasciitis
- Early diagnosis for emergency surgical debridement and broad-spectrum antibiotic therapy were the optimal treatments to reduce the mortality rate of NF 2
- Hyperbaric oxygen therapy (HBO) can be used as an adjunctive therapy in the management of NF 3, 4, 5
- The use of drotrecogin alfa may be a useful adjunct in the treatment of necrotizing fasciitis due to group A streptococcus 6
- Surgical management, including functional neck dissection, can help minimize the spread of the disease 5
- An interdisciplinary strategy of conservative therapy, including hyperbaric oxygen, should be considered in patients with necrotizing fasciitis if surgery and antibiotic treatment fail 5
Risk Factors for Mortality
- Being female, age >60, and having chronic heart disease, cirrhosis, skin necrosis, pulse rate >130/min, systolic BP <90 mmHg, and serum creatinine ≥1.6 mg/dL are risk factors for mortality in NF patients 2