From the Guidelines
Treatment of necrotizing fasciitis in pediatric patients requires immediate surgical debridement and broad-spectrum antibiotics. The primary therapeutic modality in cases of necrotizing fasciitis is surgical intervention, which is indicated when this infection is confirmed or suspected, as stated in the 2014 update by the Infectious Diseases Society of America 1. Features suggestive of necrotizing fasciitis include clinical findings, failure of cellulitis to respond to antibiotics, profound toxicity, skin necrosis, and presence of gas in the soft tissues. Most patients with necrotizing fasciitis should return to the operating room 24–36 hours after the first debridement and daily thereafter until no further need for debridement is found.
- Empiric antibiotic treatment should be broad, including agents effective against both aerobes, such as vancomycin or linezolid, and anaerobes, such as piperacillin-tazobactam or a carbapenem 1.
- Once the microbial etiology has been determined, the antibiotic coverage should be modified, with penicillin plus clindamycin recommended for treatment of documented group A streptococcal necrotizing fasciitis 1.
- Supportive care, such as fluid resuscitation and pain management, may also be necessary to manage the child's condition.
- A delayed first surgical intervention (more than 12 hours) is associated with higher mortality, and antibiotics should be given within the first 6 hours, with a duration of treatment between 7–14 days 1.
From the Research
Treatment Overview
The treatment for necrotizing fasciitis in pediatric patients typically involves a combination of surgical debridement, antibiotics, and supportive care.
- Surgical debridement is a crucial step in the treatment of necrotizing fasciitis, as it helps to remove the infected tissue and prevent the spread of the infection 2, 3.
- Antibiotics are also essential in the treatment of necrotizing fasciitis, as they help to combat the underlying bacterial infection 2, 3.
- Supportive care, such as fluid resuscitation and pain management, is also important in the treatment of necrotizing fasciitis 2, 3.
Surgical Debridement
Surgical debridement is a key component of the treatment of necrotizing fasciitis in pediatric patients.
- The goal of surgical debridement is to remove all infected tissue, including necrotic skin, subcutaneous tissue, and fascia 2, 3.
- Surgical debridement should be performed as soon as possible after diagnosis, as delayed treatment can lead to increased morbidity and mortality 2, 3.
- In some cases, multiple debridements may be necessary to ensure that all infected tissue is removed 3.
Conservative Management
Conservative management of necrotizing fasciitis in pediatric patients is also an option in some cases.
- Conservative management typically involves aggressive fluid resuscitation, broad-spectrum antibiotics, and dressing with povidone iodine ointment 4.
- Dead tissue is allowed to separate from the surrounding healthy tissue and is then removed at the bedside with minimal blood loss 4.
- Conservative management may be suitable for patients with limited disease and no signs of systemic toxicity 4.
Wound Management
Wound management is an important aspect of the treatment of necrotizing fasciitis in pediatric patients.
- After surgical debridement, the wound should be managed with dressings and topical antibiotics to promote healing 2, 3.
- In some cases, negative pressure wound therapy (NPWT) or extracellular matrix (ECM) graft placement may be used to aid in wound closure and epithelialization 5.
- The goal of wound management is to promote healing, prevent infection, and minimize scarring 2, 3.
Diagnostic Tools
Diagnostic tools, such as ultrasonography, can be useful in the diagnosis of necrotizing fasciitis in pediatric patients.