From the Guidelines
The treatment for necrotizing fasciitis in pediatric patients is primarily surgical intervention, which should be performed as soon as possible, along with broad-spectrum antimicrobial therapy and hemodynamic support.
Key Components of Treatment
- Surgical intervention: The primary therapeutic modality for necrotizing fasciitis, which involves debridement of necrotic tissue and should be repeated every 24-36 hours until no further debridement is necessary 1.
- Antimicrobial therapy: Should be administered until further debridement is no longer necessary, the patient has improved clinically, and fever has been absent for 48-72 hours, and should include agents effective against both aerobes and anaerobes, such as vancomycin, linezolid, or daptomycin combined with piperacillin-tazobactam, a carbapenem, or ceftriaxone plus metronidazole 1.
- Hemodynamic support: Aggressive fluid administration is necessary to support the patient's hemodynamic stability 1.
Additional Considerations
- Multidisciplinary approach: A multidisciplinary team, including surgeons, intensivists, and infectious disease specialists, is mandatory for the management of necrotizing fasciitis 1.
- Negative pressure wound therapy: May be considered for wound care after complete removal of necrosis 1.
- Imaging studies: Should not delay surgical treatment in severely ill and unstable patients, but can be helpful in supporting the diagnosis and aiding in surgical planning 1.
Specific Antimicrobial Regimens
- Polymicrobial necrotizing fasciitis: Should be treated with empiric therapy that includes agents effective against both aerobes and anaerobes, such as vancomycin, linezolid, or daptomycin combined with piperacillin-tazobactam, a carbapenem, or ceftriaxone plus metronidazole 1.
- Group A streptococcal necrotizing fasciitis: Should be treated with clindamycin and penicillin 1.
From the Research
Treatment Overview
The treatment for necrotizing fasciitis in pediatric patients typically involves a combination of:
- Extensive surgical debridement to remove affected tissue 2, 3, 4, 5, 6
- Broad-spectrum antibiotics to target the causative microorganisms 2, 3, 5, 6
- Supportive therapy, such as fluid resuscitation and pain management 2, 3
Surgical Debridement
Surgical debridement is a critical component of treatment, and early intervention is essential to prevent delay in treatment and improve outcomes 2, 3, 4, 5, 6. The goal of debridement is to remove all affected tissue and prevent further spread of the infection.
Antibiotic Therapy
Broad-spectrum antibiotics should be administered promptly to cover the causative microorganisms, which may include Streptococcus pyogenes, Staphylococcus epidermidis, and Pseudomonas aeruginosa 2, 3, 5, 6.
Supportive Care
Supportive care, such as continuous renal replacement therapy (CRRT), may be necessary in severe cases to prevent septic shock and support organ function 3. Additionally, techniques like Negative Pressure Wound Therapy (NPWT) and Oasis® extracellular matrix (ECM) graft placement may be used to manage residual wound defects after debridement 4.
Special Considerations
In neutropenic pediatric oncology patients, granulocyte colony-stimulating factor and granulocyte transfusions may be considered to enhance neutrophil recovery and prevent prolonged periods of neutropenia 5. A standardized approach to the pediatric patient with suspected necrotizing fasciitis is necessary to minimize delays in management and optimize antibiotic choice 6.