Article

Necrotizing fasciitis: reviewing the causes and treatment strategies.

Department of Rehabilitation Medicine, Institute of Medicine and Bioengineering, University of Pennsylvania Health System, Philadelphia, PA, USA.
Advances in Skin & Wound Care (Impact Factor: 1.63). 06/2007; 20(5):288-93; quiz 294-5. DOI: 10.1097/01.ASW.0000269317.76380.3b
Source: PubMed

ABSTRACT 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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    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.
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    ABSTRACT: Aim-BackgroundNecrotizing soft tissue infection (NSTI) is a rapidly progressive soft tissue infection with high morbidity and mortality rates. It has an incidence of approximately 1000 cases per year in the United States. Severe invasive group A Streptococcus infections associated with bacteraemia and septic shock have occurred with increasing incidence. Early recognition and prompt medical and surgical intervention are necessary to reduce morbidity and mortality rates. We present two cases of fulminant group A streptococcal necrotizing soft tissue infections. MethodDuring the last year, two patients were admitted to our clinic with fulminant necrotizing soft tissue infection caused by streptococcus pyogens. The initial lesions progressed rapidly to NSTI associated with sepsis, despite the immediate antibiotic therapy. An aggressive and extensive surgical debridement of necrotic tissue was performed. Postoperatively, continuous saline dressings were applied as well as antibiotic coverage. A plastic surgery consult was obtained to discuss closure options. ResultsDespite the initial antibiotic therapy, there were no signs of improvement until an aggressive surgical intervention was performed that showed immediate signs of recovery. ConclusionEarly diagnosis and treatment of fulminant soft tissue infections is imperative for a patient’s survival. The cornerstone of therapy of NSTI is surgical debridement, combined with appropriate antibiotic therapy and careful patient monitoring. KeywordsStreptococcus pyogens-Necrotizing soft tissue infection (NSTI)-Bacteraemia-Septic shock-Surgical intervention
    Hellēnikē cheirourgikē. Acta chirurgica Hellenica 06/2010; 82(3):213-219. DOI:10.1007/s13126-010-0025-7
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    ABSTRACT: Background Coagulase-negative staphylococci (CoNS) have been reported to cause necrotizing fasciitis; however, there are some difficulties in differentiating the roles of CoNS infections as contaminants or pathogenic isolates. Methicillin-resistant S. aureus (MRSA) has emerged as the most common isolate to cause necrotizing fasciitis in the past decade. This study was to compare the clinical presentation and surgical outcome of CoNS and MRSA monomicrobial necrotizing fasciitis, and to assess the prevalence of CoNS and MRSA infection in diabetic patients. Methods Necrotizing fasciitis caused by CoNS in 11 patients and that caused by MRSA in 27 patients was retrospectively reviewed. Demographic data, underlying diseases, laboratory results, and clinical outcome were analyzed for each patient in two groups. Results All patients underwent fasciotomy and received broad-spectrum antibiotic therapy. The mortality of MRSA group and CoNS group was 18.5 and 9%, respectively. Mortality, patient characteristics, clinical presentations, and laboratory data did not differ significantly between the two groups. Eight of CoNS patients (73%) and fourteen of MRSA patients (52%) had significant association with diabetes mellitus. Conclusions Necrotizing fasciitis caused by CoNS is a surgical emergency and should be considered to be serious as that caused by MRSA. Diabetic patients with a history of abrasion injury or chronic ulcer should be cautioned about the risk of developing CoNS and MRSA necrotizing fasciitis.
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