Necrotizing Fasciitis

Department of Rehabilitation Medicine, Institute of Medicine and Bioengineering, University of Pennsylvania Health System, Philadelphia, PA, USA.
Advances in Skin & Wound Care (Impact Factor: 1.11). 06/2007; 20(5):288-93; quiz 294-5. DOI: 10.1097/01.ASW.0000269317.76380.3b
Source: PubMed


PURPOSE: To update the practitioner with causes, diagnosis, and treatment options for necrotizing fasciitis. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in better understanding the pathophysiology, diagnosis, and treatment of necrotizing fasciitis. OBJECTIVES: After reading this article and taking this test, the reader should be able to: 1. Identify the risk factors and causes of necrotizing fasciitis (NF). 2. Describe the clinical presentation and diagnosis of NF. 3. Explain the treatment options for NF.

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    • "NF may be caused by a variety of aerobic and facultative anaerobic bacteria, including Streptococcus pyogenes or group A streptococci (GAS), Staphylococcus aureus, Escherichia coli, Clostridium and Bacteroides species [1]. Rarely, group B, C, and G streptococci, Haemophilus influenzae type b, Pseudomonas aeruginosa, Vibrio vulnificus, and fungi are involved [1]. Frequently the disease is polymicrobial [16,22]. "
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    ABSTRACT: Background The incidence and mortality from necrotizing fasciitis (NF) are increasing in New Zealand (NZ). Triggered by a media report that traditional Samoan tattooing was causing NF, we conducted a chart review to investigate the role of this and other predisposing and precipitating factors and to document NF microbiology, complications and interventions in NZ. Methods We conducted a retrospective review of 299 hospital charts of patients discharged with NF diagnosis codes in eight hospitals in NZ between 2000 and 2006. We documented and compared by ethnicity the prevalence of predisposing and precipitating conditions, bacteria isolated, complications and interventions used. Results Out of 299 charts, 247 fulfilled the case definition. NF was most common in elderly males. Diabetes was the most frequent co-morbid condition, followed by obesity. Nearly a quarter of patients were taking non-steroidal anti-inflammatory drugs (NSAID). Traditional Samoan tattooing was an uncommon cause. Streptococcus pyogenes and Staphylococcus aureus were the two commonly isolated bacteria. Methicillin-resistant Staphylococcus aureus was implicated in a relatively small number of cases. Shock, renal failure, coagulation abnormality and multi-organ dysfunction were common complications. More than 90% of patients underwent surgical debridement, 56% were admitted to an intensive care unit (ICU) and slightly less than half of all patients had blood product transfusion. One in six NF cases had amputations and 23.5% died. Conclusion This chart review found that the highest proportion of NF cases was elderly males with co-morbidities, particularly diabetes and obesity. Tattooing was an uncommon precipitating event. The role of NSAID needs further exploration. NF is a serious disease with severe complications, high case fatality and considerable use of health care resources.
    BMC Infectious Diseases 12/2012; 12(1):348. DOI:10.1186/1471-2334-12-348 · 2.61 Impact Factor
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    • "Type III of necrotizing infection is caused by the marine vibrios (Gram-negative rods). The entry portal for these bacteria is a puncture from fish or marine insects (4). "
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    ABSTRACT: Necrotizing fasciitis is a rare, life-threatening infection most commonly seen in patients with diabetes mellitus, intravenous drug abuse, and immunocompromised conditions. The extremities are the primary sites of involvement in as many as two thirds of the cases. In a significant proportion of patients, the extremities are involved as a result of trauma, needle puncture or extravasation of drugs. The infection is usually polymicrobial. Treatment involves broad-spectrum antibiotics and multiple surgical debridements or amputation. We present a patient with necrotizing fasciitis of the upper limb and present our experience with this often lethal condition.
    Trauma Monthly 07/2012; 17(2):309-312. DOI:10.5812/traumamon.6398
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    • "In our series perineal infection and surgical site infections were the most common etiologies. Despite 28.9% of our patients did not have any accompanying disease DM, malignancy and coronary artery disease were the most common co-morbidities which are also cited in other publications (Salcido, 2007). "
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    ABSTRACT: Necrotizing fasciitis (NF) is a deadly soft tissue infection characterized by necrosis of subcutaneous tissues. In this study, our aim was to identify variables affecting patient outcome and mortality in necrotizing fasciitis and their temporal changes. We reviewed records of 45 patients treated at our institution between 1979 and 2004. Data about gender, age, etiology, site of involvement, bacteriology, type of surgery, supportive treatment, accompanying diseases, mortality were collected. Factors contributing to mortality were sepsis, renal failure, liver failure, multi organ failure, disseminated intravascular coagulopathy and long term intubation. Mortalities accumulated in first 23 patients. There was not difference in microbiology, demographics, etiology, site of involvement, debridement technics between first patients and recent patients of the institution. Mortality in necrotizing fasciitis is mostly because of sepsis and associated disorders. Adequate control of the microbiological agent and preventing further contamination of the wound is cardinal part of treatment in NF.
    African journal of microbiology research 08/2011; 5(16). · 0.54 Impact Factor
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