Materiały źródłowe

• #1 Necrotizing Fasciitis Treatment & Management: Approach Considerations, Surgical Debridement, Antimicrobial Therapy

  https://emedicine.medscape.com/article/2051157-treatment

  Once the diagnosis of necrotizing fasciitis is confirmed, initiate treatment without delay. […] Because necrotizing fasciitis is a surgical emergency, the patient should be admitted immediately to a surgical intensive care unit in a setting such as a regional burn center or trauma center, where the surgical staff is skilled in performing extensive debridement and reconstructive surgery. […] A regimen of surgical debridement is continued until tissue necrosis ceases and the growth of fresh, viable tissue is observed. […] Prompt surgery ensures a higher likelihood of survival. […] Antibiotic therapy is a key consideration. Possible regimens include a combination of penicillin G and an aminoglycoside (if renal function permits), as well as clindamycin (to cover streptococci, staphylococci, gram-negative bacilli, and anaerobes).

• #2 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Necrotizing fasciitis is a subset of aggressive skin and soft tissue infections that cause muscle fascia and subcutaneous tissue necrosis. […] This activity reviews the evaluation, treatment, and prognosis of necrotizing fasciitis and highlights the role of an interprofessional team in evaluating and improving care for patients with this condition. […] The treatment of necrotizing fasciitis is surgery, and no time should be wasted calling for a surgical consult. The earlier the surgery is undertaken, the better the outcome. […] Key concepts for treatment/management of skin and soft-tissue infections are: Early diagnosis and differentiation between necrotizing and non-necrotizing skin and soft tissue infections, the early launch of appropriate empiric antibacterial coverage (wide-spectrum), adequate control of infection sources, such as aggressive surgical intervention for abscess drainage and debridement of NSTIs, identification of infection-causing pathogens and applicable adjustment of antimicrobial coverage.

• #3 Necrotizing fasciitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/821

  Necrotizing fasciitis should be suspected in any patient with a rapidly progressing soft-tissue infection and any of the following: severe pain (disproportionate to the clinical findings) or anesthesia over the site of infection; edema and erythema (edema will typically extend beyond the erythema); systemic signs of infection. […] An urgent surgical consultation should be obtained as soon as the diagnosis is suspected. Treatment should not be delayed while awaiting microbiologic and imaging investigations. […] Definitive treatment is surgical debridement, repeated as necessary. Antibiotic therapy is crucial, but is considered adjunctive to surgical management. Empiric antibiotics should cover major bacterial etiologic agents, and group A streptococcal toxin production that can accompany type II necrotizing fasciitis.

• #4 Necrotizing fasciitis: treatment concepts & clinical outcomes – an institutional experience | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-024-02638-2

  Necrotizing fasciitis is a soft tissue infection with a high mortality rate. […] Using prognostic evaluation techniques in daily clinical practice will assist medical professionals in providing adequate on-time care and significantly lowering mortality. […] Our study concludes that early extensive surgical debridement remains the single most crucial intervention in patients diagnosed with necrotizing fasciitis (NF), regardless of disease severity and the LRINEC score. […] Successful treatment requires a multidisciplinary approach to intensive care, with active fluid replacement and sepsis management, rigorous surgical debridement, and broad systemic antibiotic drugs. […] Emergency surgical debridement was planned for all patients. […] Patients were categorized as having a low (points5; 50% probability for the presence of NSTI), medium (points 67; 5075% probability for the presence of NSTI), or high risk (points8; 75% probability for the presence of NSTI) of NSTI based on the LRINEC score results.

• #5 Necrotizing fasciitis: treatment concepts & clinical outcomes – an institutional experience | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-024-02638-2

  Mortality was significantly lower in patients who underwent early surgical debridement than in those with a delay in surgical treatment (41% vs. 58%, p0.005). […] Early and thorough surgical debridement is the single most crucial intervention of choice in patients with NF, regardless of disease severity and the LRINEC score.

• #6 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  Surgery is the primary treatment for necrotizing fasciitis. The authors recommend wide, extensive debridement of all tissues that can be easily elevated off the fascia with gentle pressure. […] After the initial debridement, the wound must be carefully examined. Hemodynamic instability is usually present after surgery, and it may cause progressive skin necrosis. After debridement, the patient may return as often as necessary for further surgical debridement. Once all of the affected tissues have been debrided, soft tissue reconstruction can be considered. […] The use of adjunctive therapies, such as hyperbaric oxygen therapy (HBO), continue to receive considerable attention as integral parts of the life-saving therapies. […] Although some necrotizing infections may still be susceptible to penicillin, clindamycin is the treatment of choice for necrotizing infections.

• #7 Clinical Guidance for Type II Necrotizing Fasciitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/necrotizing-fasciitis.html

  Primary treatment is early and aggressive surgical exploration and debridement of necrotic tissue. […] Surgery is coupled with appropriate broad-spectrum parenteral antibiotic therapy. […] Upon first exploration, extensive incisions that go beyond the area of apparent involvement are usually necessary. The wound should be left open and re-inspected 24 hours later to ensure adequacy of the initial debridement. […] Antibiotic therapy is based upon Gram stain findings. Once group A strep is confirmed to be the etiology, recommended treatment is high-dose penicillin and clindamycin (interferes with toxin production). […] Intravenous immunoglobulin may be considered in cases of severe necrotizing fasciitis, although efficacy has not been proven.

• #8 The Diagnosis And Management Of Necrotising Fasciitis : Virtual Library

  https://resources.wfsahq.org/atotw/the-diagnosis-and-management-of-necrotising-fasciitis-anaesthesia-tutorial-of-the-week-298/

  Treatment of NF consists of early and aggressive debridement of necrotic tissue, together with broad-spectrum antibiotics and haemodynamic support. Treatment should be delivered by a multidisciplinary team of intensivists, microbiologists and surgeons, preferably including a plastic surgeon. […] NF is a surgical emergency and warrants immediate surgical referral. Evidence has shown that when treatment is based on just antimicrobial therapy and support, mortality approaches 100%. Surgery is a vital means of source control. The goal of surgical intervention is to aggressively debride of all the necrotic tissue until healthy, viable (bleeding) tissue is reached. […] Antibiotics are a vital adjunct to source control and may prevent the progression of septic shock when used early. In a widely quoted paper by Kumar et al effective antimicrobial administration within the first hour of documented hypotension was associated with increased survival in patients with septic shock. Furthermore, in this study which was not restricted to patients with NF, each hour of delay in administering antibiotics was associated with an average decrease in survival of 7.6%.

• #9 Clinical Guidance for Type II Necrotizing Fasciitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/necrotizing-fasciitis.html

  Primary treatment is early and aggressive surgical exploration and debridement of necrotic tissue. […] Surgery is coupled with appropriate broad-spectrum parenteral antibiotic therapy. […] Upon first exploration, extensive incisions that go beyond the area of apparent involvement are usually necessary. The wound should be left open and re-inspected 24 hours later to ensure adequacy of the initial debridement. […] Antibiotic therapy is based upon Gram stain findings. Once group A strep is confirmed to be the etiology, recommended treatment is high-dose penicillin and clindamycin (interferes with toxin production). […] Intravenous immunoglobulin may be considered in cases of severe necrotizing fasciitis, although efficacy has not been proven.

• #10 Necrotising Fasciitis – TeachMeSurgery

  https://teachmesurgery.com/plastic-surgery/infections/necrotising-fasciitis/

  Necrotising fasciitis is a surgical emergency and needs immediate resuscitation and debridement if this is deemed appropriate. It is important to remember the high mortality in this disease and assess each case individually. […] Any patient with suspected necrotising fasciitis needs urgent broad spectrum antibiotics (as per local protocol). Resuscitation intravenous fluids should be started and the patient catheterised. Any area of redness or discolouration needs to be marked and time denoted. Early contact to the intensive care team is also required. […] The only definitive management for necrotising fasciitis is urgent surgical debridement. Intra-operatively, any necrotic tissue should be excised, until only viable bleeding tissue is present. […] All cases should be packed following debridement and undergo a relook in 24-48 hours to check for evidence of infection or further necrosis (several repeat debridements may be necessary). Post-operatively, patients should be transferred to a high-dependency or intensive care unit.

• #11 Necrotising Fasciitis: Classification, Diagnosis, & Treatment

  https://www.theplasticsfella.com/necrotising-fasciitis/

  Broad-spectrum antibiotics and urgent surgical debridement are the mainstay of treatment. Multiple debridements may be required. […] Necrotising fasciitis requires prompt diagnosis, and urgent surgical and medical management to decrease the morbidity and mortality associated with this infection. […] Early anaesthetic involvement for Fluid and Cardiac Support. Immediate broad spectrum Antibiotics as per local antibiotic guidelines (adjusted later according to culture sensitivity). Suggestions for antibiotic regimen may include: Piperacillin/Tazobactam in combination with Clindamycin (1st line)* or Ceftriaxone in combination with Metronidazole (once Strep pyogenes has been ruled out). In the case of suspected MRSA Vancomycin is added to any of the above options. […] There should be no delay in urgent surgical debridement. The aims of surgical debridement are: Excision of necrotic and non-viable tissue, Washout of the involved cavity with 3-6L of 0.9% saline, Achieving a healthy wound bed, Stabilisation of the patient.

• #12 Necrotizing Fasciitis (Flesh-Eating Disease): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23103-necrotizing-fasciitis

  Necrotizing fasciitis, also known as flesh-eating disease, is a bacterial infection that affects the tissue under your skin called fascia. Its treated with antibiotics and surgery to remove damaged tissue. […] Quick intervention is needed to control necrotizing fasciitis. Youll require exploratory surgery to confirm the diagnosis of necrotizing fasciitis. Surgery is also required to remove dead tissue. It may take multiple surgeries to control the infection and remove all of the dead tissue. It takes an average of three surgeries to make sure all of the infection is gone. Your provider will also likely prescribe antibiotics and intravenous (IV) fluids. After surgery, you may need skin grafts or plastic surgery to help the wounds close completely. […] If you have this condition, your best outcome will come from receiving an accurate diagnosis and quick treatment with antibiotics combined with surgery to remove the dead tissue.

• #13 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  Surgery is the primary treatment for necrotizing fasciitis. The authors recommend wide, extensive debridement of all tissues that can be easily elevated off the fascia with gentle pressure. […] After the initial debridement, the wound must be carefully examined. Hemodynamic instability is usually present after surgery, and it may cause progressive skin necrosis. After debridement, the patient may return as often as necessary for further surgical debridement. Once all of the affected tissues have been debrided, soft tissue reconstruction can be considered. […] The use of adjunctive therapies, such as hyperbaric oxygen therapy (HBO), continue to receive considerable attention as integral parts of the life-saving therapies. […] Although some necrotizing infections may still be susceptible to penicillin, clindamycin is the treatment of choice for necrotizing infections.

• #14 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  Surgery is the primary treatment for necrotizing fasciitis. The authors recommend wide, extensive debridement of all tissues that can be easily elevated off the fascia with gentle pressure. […] After the initial debridement, the wound must be carefully examined. Hemodynamic instability is usually present after surgery, and it may cause progressive skin necrosis. After debridement, the patient may return as often as necessary for further surgical debridement. Once all of the affected tissues have been debrided, soft tissue reconstruction can be considered. […] The use of adjunctive therapies, such as hyperbaric oxygen therapy (HBO), continue to receive considerable attention as integral parts of the life-saving therapies. […] Although some necrotizing infections may still be susceptible to penicillin, clindamycin is the treatment of choice for necrotizing infections.

• #15 Necrotizing Fasciitis (Flesh-Eating Disease): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23103-necrotizing-fasciitis

  Necrotizing fasciitis, also known as flesh-eating disease, is a bacterial infection that affects the tissue under your skin called fascia. Its treated with antibiotics and surgery to remove damaged tissue. […] Quick intervention is needed to control necrotizing fasciitis. Youll require exploratory surgery to confirm the diagnosis of necrotizing fasciitis. Surgery is also required to remove dead tissue. It may take multiple surgeries to control the infection and remove all of the dead tissue. It takes an average of three surgeries to make sure all of the infection is gone. Your provider will also likely prescribe antibiotics and intravenous (IV) fluids. After surgery, you may need skin grafts or plastic surgery to help the wounds close completely. […] If you have this condition, your best outcome will come from receiving an accurate diagnosis and quick treatment with antibiotics combined with surgery to remove the dead tissue.

• #16 Necrotizing Fasciitis (Flesh-Eating Disease): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23103-necrotizing-fasciitis

  Necrotizing fasciitis, also known as flesh-eating disease, is a bacterial infection that affects the tissue under your skin called fascia. Its treated with antibiotics and surgery to remove damaged tissue. […] Quick intervention is needed to control necrotizing fasciitis. Youll require exploratory surgery to confirm the diagnosis of necrotizing fasciitis. Surgery is also required to remove dead tissue. It may take multiple surgeries to control the infection and remove all of the dead tissue. It takes an average of three surgeries to make sure all of the infection is gone. Your provider will also likely prescribe antibiotics and intravenous (IV) fluids. After surgery, you may need skin grafts or plastic surgery to help the wounds close completely. […] If you have this condition, your best outcome will come from receiving an accurate diagnosis and quick treatment with antibiotics combined with surgery to remove the dead tissue.

• #17 Necrotizing Fasciitis: Treatment and Recovery – Nursing CE Central

  https://nursingcecentral.com/lessons/necrotizing-fasciitis-treatment-and-recovery/

  Hemolytic stability will return once the necrotic tissue is removed. Amputations may be needed if the necrotic tissue is not removed. The surgical wound needs to be kept open and is usually packed with wet gauze. Daily dressing changes are needed to keep the wound clean. After the necrotic tissue is removed and the patient begins to stabilize, reconstructive surgery may be necessary. […] In some cases, the surgical wound cannot be closed, and a plastic surgeon may be consulted for reconstruction. A grafted skin flap may be needed to close the wound. This would be done in subsequent surgeries. Necrotizing fasciitis requires a multidisciplinary care team for treatment and management.

• #18 Necrotizing Fasciitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/25623

  The plastic surgeon should be consulted once all the necrotic tissue is removed and there is evidence of granulation tissue. In most cases, primary closure is not possible, and hence the plastic surgeon may be required to reconstruct the soft tissues and close the wound with a muscle flap. […] Hyperbaric oxygen therapy may be effective for small wounds, but there is no evidence that this therapy improves healing or prolongs life for large wounds. Finally, it should be noted that hyperbaric oxygen therapy is an adjunctive treatment and not a substitute for surgical debridement. Hyperbaric oxygen treatment may be useful when the patient is stable. Some data show that this treatment can help reduce mortality. Hyperbaric oxygen is not a substitute for surgery but a complementary treatment.

• #19 Necrotising fasciitis

  https://www.nhs.uk/conditions/necrotising-fasciitis/

  Necrotising fasciitis gets worse quickly and can be fatal. It must be treated in hospital as soon as possible. […] Treatment will usually include: antibiotics, surgery to remove the affected area. […] Even after successful treatment, there may be long-term changes in how your body looks and how you move or use the affected part of your body. Sometimes amputation of affected limbs is needed. […] You may need further surgery and physiotherapy to help you recover.

• #20 Necrotizing Fasciitis (Flesh-Eating Bacteria): Causes, Symptoms, and Treatment

  https://www.webmd.com/skin-problems-and-treatments/necrotizing-fasciitis-flesh-eating-bacteria

  If you’re infected with flesh-eating bacteria, you will get several types of treatment. The extent of treatment depends on the stage of the disease when treatment is started but can include: […] Intravenous (IV) antibiotic therapy […] Surgery to remove damaged or dead tissue in order to stop the spread of infection […] Medications to raise blood pressure […] Amputations of affected limbs, in some cases […] Hyperbaric oxygen therapy to preserve healthy tissue […] Cardiac monitoring and breathing aids […] Blood transfusions […] Intravenous immunoglobulin, which helps the body fight infection.

• #21 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Necrotizing fasciitis is a subset of aggressive skin and soft tissue infections that cause muscle fascia and subcutaneous tissue necrosis. […] This activity reviews the evaluation, treatment, and prognosis of necrotizing fasciitis and highlights the role of an interprofessional team in evaluating and improving care for patients with this condition. […] The treatment of necrotizing fasciitis is surgery, and no time should be wasted calling for a surgical consult. The earlier the surgery is undertaken, the better the outcome. […] Key concepts for treatment/management of skin and soft-tissue infections are: Early diagnosis and differentiation between necrotizing and non-necrotizing skin and soft tissue infections, the early launch of appropriate empiric antibacterial coverage (wide-spectrum), adequate control of infection sources, such as aggressive surgical intervention for abscess drainage and debridement of NSTIs, identification of infection-causing pathogens and applicable adjustment of antimicrobial coverage.

• #22 Necrotizing Fasciitis of the Upper Extremity – A Review | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/35320-necrotizing-fasciitis-of-the-upper-extremity-a-review

  The goal of treatment is the eradication of the infection while maintaining the maximum possible function of the extremity. Early recognition, appropriate antibiotic treatment, and surgical intervention are mandatory. […] Because of the destruction of soft tissue structures, that characterizes necrotizing fasciitis, the adequate delivery of antibiotics in the infection site is compromised. Therefore, treatment with antibiotics alone is of little value in the management of the disease. However, they play an important role combined with surgical debridement and that is the reason why the immediate administration of broad-spectrum antibiotics in patients with suspected necrotizing fasciitis is justified. […] Appropriate and early surgical debridement remains the cornerstone of treatment in cases of necrotizing fasciitis. The goal is to remove all the necrotic tissues while preserving the motor and sensory function of the extremity. Many studies support that early and aggressive surgical debridement increases the rate of survival and that delay in surgical treatment greater than 24h since admission, affects the mortality rate.

• #23 Necrotising fasciitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/821

  Necrotising fasciitis is a life-threatening subcutaneous soft-tissue infection that requires a high index of suspicion for diagnosis. […] If you suspect necrotising fasciitis, immediately refer the patient for urgent surgical debridement; do not wait for the results of investigations before referral. […] Surgical debridement should be repeated as necessary until the patient has no necrotic tissue remaining. […] Adjunctive antibiotic therapy and supportive care is crucial. Start intravenous empirical antibiotics as soon as you have obtained blood cultures. Once culture results are available, tailor the antibiotics to target the causative organism.

• #24 Necrotizing Fasciitis Treatment & Management: Approach Considerations, Surgical Debridement, Antimicrobial Therapy

  https://emedicine.medscape.com/article/2051157-treatment

  Once all of the affected tissues have been debrided, soft tissue reconstruction can be considered. […] Empiric antibiotics should be started immediately. […] Initial antimicrobial therapy should be broad-based, to cover aerobic gram-positive and gram-negative organisms and anaerobes. […] Successful use of intravenous immunoglobulin (IVIG) has been reported in the treatment of streptococcal toxic shock syndrome. […] Once other modalities, including surgical debridement and antibiotic administration, have been used, hyperbaric oxygen therapy (HBOT) may be considered, if available. […] The literature suggests that HBOT can reduce mortality when used as part of an aggressive treatment regimen for necrotizing fasciitis. […] A team approach is the best method of treating this complicated disorder.

• #25 Necrotizing Fasciitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/25623

  Antimicrobial therapy for necrotizing fasciitis is as follows: Imipenem 1 g every 6 to 8 hours, daptomycin 6 mg/kg QD, and clindamycin 600 mg to 900 mg 4 times daily. Piperacillin/tazobactam 3.375 g every 6 hours or 4.5 g every 8 hours, daptomycin 6 mg/kg QD, and clindamycin 600 mg to 900 mg 4 times daily. Meropenem 1 g IV every 8 hours, vancomycin 15 to 20 mg/kg/dose every 8 to 12 hours, and clindamycin 600 mg to 900 mg 4 times daily. […] The treatment of necrotizing fasciitis is surgery, and no time should be wasted calling for a surgical consult. The earlier the surgery is undertaken, the better the outcome. The surgery requires extensive, wide debridement of all necrotic tissues. In some cases, a second-look surgery may also be required. Early surgery may help minimize tissue loss and eliminate the need for amputation of a gangrenous extremity.

• #26 Necrotizing Soft-Tissue Infection – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/necrotizing-soft-tissue-infection

  Treatment of early NSTI and clostridial myonecrosis is primarily surgical, which should not be delayed by diagnostic studies. […] Evidence of bullae, ecchymosis, fluctuance, crepitus, and systemic spread of infection requires immediate surgical exploration and debridement. The initial incision should be extended until an instrument or finger can no longer separate the skin and subcutaneous tissue from the deep fascia. The most common error is insufficient surgical intervention; repeat operation every 1 to 2 days, with further incision and debridement as needed, should be carried out routinely. Negative-pressure wound therapy (NPWT, also called vacuum-assisted closure, or VAC), which applies suction to the wound, has been used as an adjunct for care between debridements. […] IV antibiotics are adjuncts, usually including 2 or more medications. An empiric regimen should include antibiotics effective against aerobic and anaerobic organisms. Current recommendations from the Infectious Diseases Society of America (IDSA) suggest vancomycin, linezolid, or daptomycin combined with piperacillin/tazobactam, a carbapenem, ceftriaxone plus metronidazole, or a fluoroquinolone plus metronidazole. Antibiotic coverage should be narrowed based on blood and tissue culture results once they become available. […] IV immune globulin has been suggested as adjunctive therapy for streptococcal toxic shock syndrome with NSTI.

• #27 Necrotizing Fasciitis – Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/necrotizing-fasciitis-treatment/

  Necrotizing fasciitis is a rare but life/limb threatening disease and is a true surgical emergency. There are about 100 cases annually in Canada (1/350,000). […] The management of necrotizing fasciitis is surgical, so early referral is key. […] The definitive treatment of necrotizing fasciitis is surgery. […] Antibiotics should be administered early. Piperacillin-tazobactam 3.375 grams IV OR Penicillin 4 million units IV with vancomycin (weight based dosing) is recommended. […] In penicillin allergic patients, ertapenem 1 gram IV is a reasonable alternative, again with vancomycin. […] There is some evidence (animal studies) that adding clindamycin (900 mg IV) to the above regimens, helps with synergy and decreasing inflammation. […] There is no role for corticosteroids. […] There is no evidence that hyperbaric oxygen adds benefit.

• #28 The Diagnosis And Management Of Necrotising Fasciitis : Virtual Library

  https://resources.wfsahq.org/atotw/the-diagnosis-and-management-of-necrotising-fasciitis-anaesthesia-tutorial-of-the-week-298/

  Broad-spectrum antibiotics should be commenced immediately to include coverage of gram positive, gram negative and anaerobic organisms. GAS NF is almost always penicillin sensitive but high concentrations of the bacteria in the tissue results in most bacteria being in the stationary phase of the growth cycle, making antibiotics that target cell wall synthesis ineffective. Clindamycin is a lincosamide antibiotic that can switch off exotoxin production even in the stationary phase. […] Patients with NF frequently develop septic shock and multi-organ failure. Other common complications include disseminated-intra-vascular coagulation, adult respiratory distress syndrome, acidosis and hypothermia. In addition to this patients will often have large areas of skin and subcutaneous tissue debrided at a time, resulting in a large third space loss of fluid that is difficult to quantify. Patients should be managed in a critical care setting with close cardiac output monitoring, access to inotropic support and tight glycaemic control.

• #29

  https://www.orthobullets.com/trauma/1007/necrotizing-fasciitis

  Necrotizing Fasciitis is a life-threatening bacterial soft tissue infection that spreads along soft tissue planes rapidly. […] Treatment is emergent radical debridement of all devitalized tissues with broad-spectrum IV antibiotics. […] Operative emergent radical debridement and broad-spectrum IV antibiotics. […] initial antibiotics start empirically with penicillin, clindamycin, metronidazole, and an aminoglycoside. […] clindamycin has been shown to reduce odds of limb amputation. […] definitive antibiotics include penicillin G for strep or clostridium, imipenem or doripenem or meropenem for polymicrobial, and add vancomycin or daptomycin if MRSA suspected. […] hemodynamic monitoring with systemic resuscitation is critical. […] hyperbaric oxygen chamber if anaerobic organism identified. […] low threshold for amputation when life threatening.

• #30 Necrotising fasciitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/821

  Necrotising fasciitis is a life-threatening subcutaneous soft-tissue infection that requires a high index of suspicion for diagnosis. […] If you suspect necrotising fasciitis, immediately refer the patient for urgent surgical debridement; do not wait for the results of investigations before referral. […] Surgical debridement should be repeated as necessary until the patient has no necrotic tissue remaining. […] Adjunctive antibiotic therapy and supportive care is crucial. Start intravenous empirical antibiotics as soon as you have obtained blood cultures. Once culture results are available, tailor the antibiotics to target the causative organism.

• #31 Necrotizing Soft-Tissue Infection: Disease Overview and Updated Treatment Strategies

  https://www.uspharmacist.com/article/necrotizing-softtissue-infection-disease-overview-and-updated-treatment-strategies

  Definitive management of NSTI involves a variety of antibiotic agents. For polymicrobial infections, broad-spectrum antibiotic therapy is often continued. In the presence of infections caused by GAS, both clindamycin and penicillin should be used. […] Antibiotic therapy is typically continued until no further debridement is necessary, the patient has shown clinical improvement, and fever has been absent for 48 to 72 hours. […] Since the publication of the 2014 IDSA guidelines, several new antibiotics have been approved for use in the management of complicated skin and soft-tissue infections. […] Adjunctive therapies for NSTI include IV immunoglobulin (IVIG) and hyperbaric oxygen therapy. […] Hyperbaric oxygen therapy (HBOT) has been advocated for the management of gas gangrene, but its role is controversial.

• #32 Necrotizing Fasciitis | Infectious Diseases Management Program at UCSF

  https://idmp.ucsf.edu/content/necrotizing-fasciitis

  Patient Population: Pediatric […] Urgent Surgery consult recommended […] ID consult recommended […] Therapy should be modified as indicated based on isolated pathogen(s), including narrowing the initial regimen to target identified pathogen(s) and stopping clindamycin after initial clinical improvement. […] Duration: 7-14 days, guided by response to therapy. Continue until further debridement is not necessary, patient has clinically improved, and is afebrile for 48-72 hours.

• #33 Necrotizing Soft-Tissue Infection: Disease Overview and Updated Treatment Strategies

  https://www.uspharmacist.com/article/necrotizing-softtissue-infection-disease-overview-and-updated-treatment-strategies

  Definitive management of NSTI involves a variety of antibiotic agents. For polymicrobial infections, broad-spectrum antibiotic therapy is often continued. In the presence of infections caused by GAS, both clindamycin and penicillin should be used. […] Antibiotic therapy is typically continued until no further debridement is necessary, the patient has shown clinical improvement, and fever has been absent for 48 to 72 hours. […] Since the publication of the 2014 IDSA guidelines, several new antibiotics have been approved for use in the management of complicated skin and soft-tissue infections. […] Adjunctive therapies for NSTI include IV immunoglobulin (IVIG) and hyperbaric oxygen therapy. […] Hyperbaric oxygen therapy (HBOT) has been advocated for the management of gas gangrene, but its role is controversial.

• #34 Necrotizing Fasciitis Treatment & Management: Approach Considerations, Surgical Debridement, Antimicrobial Therapy

  https://emedicine.medscape.com/article/2051157-treatment

  Once all of the affected tissues have been debrided, soft tissue reconstruction can be considered. […] Empiric antibiotics should be started immediately. […] Initial antimicrobial therapy should be broad-based, to cover aerobic gram-positive and gram-negative organisms and anaerobes. […] Successful use of intravenous immunoglobulin (IVIG) has been reported in the treatment of streptococcal toxic shock syndrome. […] Once other modalities, including surgical debridement and antibiotic administration, have been used, hyperbaric oxygen therapy (HBOT) may be considered, if available. […] The literature suggests that HBOT can reduce mortality when used as part of an aggressive treatment regimen for necrotizing fasciitis. […] A team approach is the best method of treating this complicated disorder.

• #35 Necrotizing Fasciitis Treatment & Management: Approach Considerations, Surgical Debridement, Antimicrobial Therapy

  https://emedicine.medscape.com/article/2051157-treatment

  While the literature appears to support the use of hyperbaric oxygen as an adjunctive treatment measure in patients with necrotizing fasciitis, transfer to a hospital equipped with a hyperbaric oxygen chamber should not delay emergency surgical intervention. […] Surgery is the primary treatment for necrotizing fasciitis. Surgeons must be consulted early in the care of these patients, as early and aggressive surgical debridement of necrotic tissue can be life-saving. […] The authors recommend wide, extensive debridement of all tissues that can be easily elevated off the fascia with gentle pressure. […] Following each debridement of the necrotic tissue, daily antibiotic dressings are recommended. […] Silver sulfadiazine (Silvadene) remains the most popular antimicrobial cream. […] Mafenide is an alternate agent that penetrates eschar more effectively than silver sulfadiazine.

• #36 Necrotizing fasciitis: strategies for diagnosis and management | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/1749-7922-2-19

  Hyperbaric oxygen therapy (HBO) treatment increase tissue oxygenation in both healthy tissue and in the vicinity of infected tissue. […] Hyperbaric oxygen-therapy was administered at 2.5 to 3.0 atmospheres for 90 min twice daily, following surgical debridement until no ongoing necrosis was evident in patients with clostridial infections. […] The mortality rates are still very high in NF due to the severe sepsis that necessitates other interventions to overcome sepsis-related mortality.

• #37 09. Necrotizing Soft Tissue Infections – Undersea & Hyperbaric Medical Society

  https://www.uhms.org/9-necrotizing-soft-tissue-infections.html

  Hyperbaric oxygen therapy is a recognized accepted adjunct to surgical debridements, antibiotic therapy and maximal goal-directed critical care therapy for infections of soft tissues resulting in necrosis. […] Hyperbaric oxygen therapy can reduce the amount of hypoxic leukocyte dysfunction occurring within an area of hypoxia and infection, and provide oxygenation to otherwise ischemic areas, thus limiting the spread and progression of infection. […] In cases where the antibiotic being used requires oxygen for transport across cell walls, hyperbaric oxygen therapy can act to enhance antibiotic penetration into target bacteria. […] Numerous studies have continued to demonstrate the beneficial effect of hyperbaric oxygen therapy in the management of necrotizing fasciitis. […] Hyperbaric oxygen therapy increased survival with an odds ratio of 8.9 (95% confidence interval, 1.3-58.0) and a number of 3 needed to treat to benefit.

• #38 The Diagnosis And Management Of Necrotising Fasciitis : Virtual Library

  https://resources.wfsahq.org/atotw/the-diagnosis-and-management-of-necrotising-fasciitis-anaesthesia-tutorial-of-the-week-298/

  Several studies have looked at the role of intravenous immunoglobulins (IVIG) in NF. […] IVIG appears to be useful in GAS infections as they contain neutralizing antibodies that act against streptococcal antigens. […] Hyperbaric oxygen (HBO) is thought to increase the bactericidal effects of neutrophils since at low oxygen tensions killing mechanisms reliant on oxygen free radicals are less effective. […] When used to treat infections, HBO should be implemented early with two to three ninety-minute sessions at 3 atm. These high pressures maintain oxygen tension above 300 mmHg, which is sufficient to inhibit clostridial spore and exotoxin production.

• #39 09. Necrotizing Soft Tissue Infections – Undersea & Hyperbaric Medical Society

  https://www.uhms.org/9-necrotizing-soft-tissue-infections.html

  Hyperbaric oxygen therapy is a recognized accepted adjunct to surgical debridements, antibiotic therapy and maximal goal-directed critical care therapy for infections of soft tissues resulting in necrosis. […] Hyperbaric oxygen therapy can reduce the amount of hypoxic leukocyte dysfunction occurring within an area of hypoxia and infection, and provide oxygenation to otherwise ischemic areas, thus limiting the spread and progression of infection. […] In cases where the antibiotic being used requires oxygen for transport across cell walls, hyperbaric oxygen therapy can act to enhance antibiotic penetration into target bacteria. […] Numerous studies have continued to demonstrate the beneficial effect of hyperbaric oxygen therapy in the management of necrotizing fasciitis. […] Hyperbaric oxygen therapy increased survival with an odds ratio of 8.9 (95% confidence interval, 1.3-58.0) and a number of 3 needed to treat to benefit.

• #40 09. Necrotizing Soft Tissue Infections – Undersea & Hyperbaric Medical Society

  https://www.uhms.org/9-necrotizing-soft-tissue-infections.html

  The group treated with hyperbaric oxygen had a mortality rate of 7%, versus 42% in the group not receiving hyperbaric oxygen (p=.04), with a combined overall mortality rate of 23%. […] Hyperbaric oxygenation was observed to reduce systemic toxicity, prevent extension of the necrotizing process, and increased demarcation, improving overall outcomes. […] With such strong case series evidence of reductions in morbidity and mortality for necrotizing fasciitis and the subset of Fournier’s Gangrene, it is difficult to envision ever seeing a controlled, double-blinded study of hyperbaric oxygen therapy.

• #41 Necrotizing fasciitis: strategies for diagnosis and management | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/1749-7922-2-19

  Hyperbaric oxygen therapy (HBO) treatment increase tissue oxygenation in both healthy tissue and in the vicinity of infected tissue. […] Hyperbaric oxygen-therapy was administered at 2.5 to 3.0 atmospheres for 90 min twice daily, following surgical debridement until no ongoing necrosis was evident in patients with clostridial infections. […] The mortality rates are still very high in NF due to the severe sepsis that necessitates other interventions to overcome sepsis-related mortality.

• #42 Necrotizing Fasciitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/25623

  The plastic surgeon should be consulted once all the necrotic tissue is removed and there is evidence of granulation tissue. In most cases, primary closure is not possible, and hence the plastic surgeon may be required to reconstruct the soft tissues and close the wound with a muscle flap. […] Hyperbaric oxygen therapy may be effective for small wounds, but there is no evidence that this therapy improves healing or prolongs life for large wounds. Finally, it should be noted that hyperbaric oxygen therapy is an adjunctive treatment and not a substitute for surgical debridement. Hyperbaric oxygen treatment may be useful when the patient is stable. Some data show that this treatment can help reduce mortality. Hyperbaric oxygen is not a substitute for surgery but a complementary treatment.

• #43 Necrotizing Fasciitis Treatment, Symptoms, Pictures, Diagnosis & Causes of Flesh-Eating Disease

  https://www.medicinenet.com/necrotizing_fasciitis/article.htm

  Although not available in many hospitals, hyperbaric oxygen therapy (oxygen given under pressure with the patient in a specialized chamber) is sometimes used in treatment as the oxygen can inhibit or stop anaerobic bacterial growth and promote tissue recovery. This therapy does not replace antibiotics or surgical treatment. However, hyperbaric oxygen therapy has been shown by researchers to further reduce morbidity and mortality by about 10%-20% in some patients when used in conjunction with antibiotics and surgery. […] The duration of treatment for necrotizing fasciitis is highly variable and often depends upon the extent of the disease and how well the patient responds to treatments. Patients with extensive disease may take months of treatment especially if they need skin grafting and/or plastic surgery.

• #44 Necrotizing Fasciitis Treatment & Management: Approach Considerations, Surgical Debridement, Antimicrobial Therapy

  https://emedicine.medscape.com/article/2051157-treatment

  Once all of the affected tissues have been debrided, soft tissue reconstruction can be considered. […] Empiric antibiotics should be started immediately. […] Initial antimicrobial therapy should be broad-based, to cover aerobic gram-positive and gram-negative organisms and anaerobes. […] Successful use of intravenous immunoglobulin (IVIG) has been reported in the treatment of streptococcal toxic shock syndrome. […] Once other modalities, including surgical debridement and antibiotic administration, have been used, hyperbaric oxygen therapy (HBOT) may be considered, if available. […] The literature suggests that HBOT can reduce mortality when used as part of an aggressive treatment regimen for necrotizing fasciitis. […] A team approach is the best method of treating this complicated disorder.

• #45 Clinical Guidance for Type II Necrotizing Fasciitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/necrotizing-fasciitis.html

  Primary treatment is early and aggressive surgical exploration and debridement of necrotic tissue. […] Surgery is coupled with appropriate broad-spectrum parenteral antibiotic therapy. […] Upon first exploration, extensive incisions that go beyond the area of apparent involvement are usually necessary. The wound should be left open and re-inspected 24 hours later to ensure adequacy of the initial debridement. […] Antibiotic therapy is based upon Gram stain findings. Once group A strep is confirmed to be the etiology, recommended treatment is high-dose penicillin and clindamycin (interferes with toxin production). […] Intravenous immunoglobulin may be considered in cases of severe necrotizing fasciitis, although efficacy has not been proven.

• #46 The Diagnosis And Management Of Necrotising Fasciitis : Virtual Library

  https://resources.wfsahq.org/atotw/the-diagnosis-and-management-of-necrotising-fasciitis-anaesthesia-tutorial-of-the-week-298/

  Several studies have looked at the role of intravenous immunoglobulins (IVIG) in NF. […] IVIG appears to be useful in GAS infections as they contain neutralizing antibodies that act against streptococcal antigens. […] Hyperbaric oxygen (HBO) is thought to increase the bactericidal effects of neutrophils since at low oxygen tensions killing mechanisms reliant on oxygen free radicals are less effective. […] When used to treat infections, HBO should be implemented early with two to three ninety-minute sessions at 3 atm. These high pressures maintain oxygen tension above 300 mmHg, which is sufficient to inhibit clostridial spore and exotoxin production.

• #47 Necrotizing Fasciitis: Pearls & Pitfalls – emDocs

  https://www.emdocs.net/necrotizing-fasciitis-pearls-pitfalls/

  The treatment of necrotizing fasciitis involves wide surgical debridement, broad-spectrum antibiotics, and hemodynamic support. The choice of antibiotics will vary based on the suspected organisms involved, as well as the local incidence of MRSA and drug susceptibilities. Most accepted regimens include coverage of gram-positive and gram-negative organisms and anaerobes. Here are some considerations for antibiotic selection based on the suspected type of infection and the organisms involved: […] An acceptable regimen to initiate in the emergency department includes a carbapenem or beta-lactam-beta-lactamase inhibitor plus clindamycin and an agent directed against MRSA. Tissue ischemia will impair antibiotic delivery to the infected tissue and therefore, they are ineffective alone. Definitive treatment is source control with wide surgical debridement. Once the patient is hospitalized, antibiotics will be tailored based on gram stain, culture and sensitivity results. For GAS infections complicated by TSS, the administration of IVIG should be considered as an adjunctive therapy and has been shown to improve outcomes.

• #48 Necrotizing Fasciitis – EyeWiki

  https://eyewiki.org/Necrotizing_Fasciitis

  Hyperbaric oxygen (HBO) therapy may also play a role in the treatment of NF and orbital NF. HBO therapy has been show to reduce mortality and improve tissue viability. This is likely achieved by HBO therapy’s role in inhibition of exotoxin production, leucocyte function, and attaining sufficient tissue oxygen levels to kill strict anaerobes. […] After the initial infection is controlled and surgical debridement completed, there can be large areas left to heal. Survivors of NF and periorbital NF can have substantial cosmetic and functional defects. Negative-pressure wound therapy (NPWT) is currently being employed to facilitate debridement, to promote wound healing and granulation tissue development, and to act as a bridge allowing temporary wound closure. […] The key to the successful treatment of NF is early and aggressive diagnosis and treatment.

• #49 Necrotising fasciitis and septic shock: A case report of a patient receiving an immunomodulatory agent for multiple sclerosis – Wounds International

  https://woundsinternational.com/journal-articles/necrotising-fasciitis-and-septic-shock-a-case-report-of-a-patient-receiving-an-immunomodulatory-agent-for-multiple-sclerosis/

  Delays in the surgical debridement may be fatal, as the infection expands fast and it is crucial for the recovery of the patient to keep as many healthy tissues as possible. […] Another factor that contributed to the positive outcome was the timely decision to perform a second look surgical intervention without any signs of deterioration, 48 hours after the first operation. […] Furthermore, at that early stage and despite the difficult anatomical region, we applied NPWT. NPWT provides several benefits to the wound; it keeps it clean by constantly draining and removing infected fluids, which reduces the size of the bacterial load. […] Even though surgical debridement and antibiotic agents are considered the main therapy of NF, Hyperbaric oxygen therapy (HBOT) and intravenous immunoglobulin (IVIG) therapy have been proposed as adjunct therapies.

• #50 Necrotising fasciitis management: a case study – Wounds UK

  https://wounds-uk.com/journal-articles/necrotising-fasciitis-management-a-case-study/

  Early diagnosis, preferably within four hours, and surgical management are integral in reducing the spread of this severe infection, while delays in treatment, of more than 12 hours can be fatal (Misiakos and Bagias, 2017). […] Misiakos and Bagias (2017) suggest further debridement surgery is usually required with necrotising fasciitis until healthy tissue is found and there is no further evidence of the spread of infection. Wound debridement in necrotising fasciitis cases is extensive to ensure that all necrotic and infected tissue is removed, and are as wide as the rim of the cellulitis (Duan et all, 2020). […] The wound was assessed and found to be stable and appropriate for the use of negative pressure wound therapy (NPWT). Li et al (2015) say the timing for wound closure is essential, if the wound is closed too early there is a risk of residual infection and poor healing. NPWT is an effective method for management of necrotising fasciitis as it removes infected material from the wound bed that can hinder tissue healing, (Sammoni et al, 2012). Negative pressure creates the ideal wound healing environment, by increasing granulation and local blood perfusion (Li et al, 2015).

• #51 Necrotizing Soft-Tissue Infection – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/necrotizing-soft-tissue-infection

  Treatment of early NSTI and clostridial myonecrosis is primarily surgical, which should not be delayed by diagnostic studies. […] Evidence of bullae, ecchymosis, fluctuance, crepitus, and systemic spread of infection requires immediate surgical exploration and debridement. The initial incision should be extended until an instrument or finger can no longer separate the skin and subcutaneous tissue from the deep fascia. The most common error is insufficient surgical intervention; repeat operation every 1 to 2 days, with further incision and debridement as needed, should be carried out routinely. Negative-pressure wound therapy (NPWT, also called vacuum-assisted closure, or VAC), which applies suction to the wound, has been used as an adjunct for care between debridements. […] IV antibiotics are adjuncts, usually including 2 or more medications. An empiric regimen should include antibiotics effective against aerobic and anaerobic organisms. Current recommendations from the Infectious Diseases Society of America (IDSA) suggest vancomycin, linezolid, or daptomycin combined with piperacillin/tazobactam, a carbapenem, ceftriaxone plus metronidazole, or a fluoroquinolone plus metronidazole. Antibiotic coverage should be narrowed based on blood and tissue culture results once they become available. […] IV immune globulin has been suggested as adjunctive therapy for streptococcal toxic shock syndrome with NSTI.

• #52 The Diagnosis And Management Of Necrotising Fasciitis : Virtual Library

  https://resources.wfsahq.org/atotw/the-diagnosis-and-management-of-necrotising-fasciitis-anaesthesia-tutorial-of-the-week-298/

  Broad-spectrum antibiotics should be commenced immediately to include coverage of gram positive, gram negative and anaerobic organisms. GAS NF is almost always penicillin sensitive but high concentrations of the bacteria in the tissue results in most bacteria being in the stationary phase of the growth cycle, making antibiotics that target cell wall synthesis ineffective. Clindamycin is a lincosamide antibiotic that can switch off exotoxin production even in the stationary phase. […] Patients with NF frequently develop septic shock and multi-organ failure. Other common complications include disseminated-intra-vascular coagulation, adult respiratory distress syndrome, acidosis and hypothermia. In addition to this patients will often have large areas of skin and subcutaneous tissue debrided at a time, resulting in a large third space loss of fluid that is difficult to quantify. Patients should be managed in a critical care setting with close cardiac output monitoring, access to inotropic support and tight glycaemic control.

• #53 Necrotizing Fasciitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/25623

  These extremely ill patients should be transferred immediately to the intensive care unit. The sepsis causes refractory hypotension and diffuse capillary leak. Thus, the patient will need aggressive resuscitation with fluids and the use of inotropes to maintain blood pressure. The patient must be kept NPO (nothing by mouth) until seen by the surgeon. Nutrition is vital, but only after surgery has been completed. Enteral feedings should be started as soon as the patient is hemodynamically stable. The enteral feedings may help offset the massive negative protein balance due to catabolism.[5][12][13](B2) […] Key concepts for treatment/management of skin and soft-tissue infections are: Early diagnosis and differentiation between necrotizing and non-necrotizing skin and soft tissue infections. The early launch of appropriate empiric antibacterial coverage (wide-spectrum). Adequate control of infection sources, such as aggressive surgical intervention for abscess drainage and debridement of NSTIs. Identification of infection-causing pathogens and applicable adjustment of antimicrobial coverage.

• #54 Necrotizing Fasciitis – Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/necrotizing-fasciitis-treatment/

  Patients with necrotizing fasciitis frequently are in septic shock, and it is crucial to manage this as well. […] All patients with suspected necrotizing fasciitis require hospital admission. […] Necrotizing fasciitis treatment requires highly specialized care, including surgery or plastic surgery services as well as intensive care. Transfer to another facility must be weighed against the observation that patients with necrotizing fasciitis are frequently unstable. […] Suspicion of necrotizing fasciitis necessitates early referral to surgery/plastic surgery. […] It is better to refer early, and have the diagnosis be a severe case of cellulitis as opposed to waiting too long for a diagnosis of necrotizing fasciitis.

• #55 The Diagnosis And Management Of Necrotising Fasciitis : Virtual Library

  https://resources.wfsahq.org/atotw/the-diagnosis-and-management-of-necrotising-fasciitis-anaesthesia-tutorial-of-the-week-298/

  Broad-spectrum antibiotics should be commenced immediately to include coverage of gram positive, gram negative and anaerobic organisms. GAS NF is almost always penicillin sensitive but high concentrations of the bacteria in the tissue results in most bacteria being in the stationary phase of the growth cycle, making antibiotics that target cell wall synthesis ineffective. Clindamycin is a lincosamide antibiotic that can switch off exotoxin production even in the stationary phase. […] Patients with NF frequently develop septic shock and multi-organ failure. Other common complications include disseminated-intra-vascular coagulation, adult respiratory distress syndrome, acidosis and hypothermia. In addition to this patients will often have large areas of skin and subcutaneous tissue debrided at a time, resulting in a large third space loss of fluid that is difficult to quantify. Patients should be managed in a critical care setting with close cardiac output monitoring, access to inotropic support and tight glycaemic control.

• #56 Necrotizing Fasciitis (Flesh-Eating Bacteria): Causes, Symptoms, and Treatment

  https://www.webmd.com/skin-problems-and-treatments/necrotizing-fasciitis-flesh-eating-bacteria

  If you’re infected with flesh-eating bacteria, you will get several types of treatment. The extent of treatment depends on the stage of the disease when treatment is started but can include: […] Intravenous (IV) antibiotic therapy […] Surgery to remove damaged or dead tissue in order to stop the spread of infection […] Medications to raise blood pressure […] Amputations of affected limbs, in some cases […] Hyperbaric oxygen therapy to preserve healthy tissue […] Cardiac monitoring and breathing aids […] Blood transfusions […] Intravenous immunoglobulin, which helps the body fight infection.

• #57 Necrotizing Fasciitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/25623

  These extremely ill patients should be transferred immediately to the intensive care unit. The sepsis causes refractory hypotension and diffuse capillary leak. Thus, the patient will need aggressive resuscitation with fluids and the use of inotropes to maintain blood pressure. The patient must be kept NPO (nothing by mouth) until seen by the surgeon. Nutrition is vital, but only after surgery has been completed. Enteral feedings should be started as soon as the patient is hemodynamically stable. The enteral feedings may help offset the massive negative protein balance due to catabolism.[5][12][13](B2) […] Key concepts for treatment/management of skin and soft-tissue infections are: Early diagnosis and differentiation between necrotizing and non-necrotizing skin and soft tissue infections. The early launch of appropriate empiric antibacterial coverage (wide-spectrum). Adequate control of infection sources, such as aggressive surgical intervention for abscess drainage and debridement of NSTIs. Identification of infection-causing pathogens and applicable adjustment of antimicrobial coverage.

• #58 The Diagnosis And Management Of Necrotising Fasciitis : Virtual Library

  https://resources.wfsahq.org/atotw/the-diagnosis-and-management-of-necrotising-fasciitis-anaesthesia-tutorial-of-the-week-298/

  Broad-spectrum antibiotics should be commenced immediately to include coverage of gram positive, gram negative and anaerobic organisms. GAS NF is almost always penicillin sensitive but high concentrations of the bacteria in the tissue results in most bacteria being in the stationary phase of the growth cycle, making antibiotics that target cell wall synthesis ineffective. Clindamycin is a lincosamide antibiotic that can switch off exotoxin production even in the stationary phase. […] Patients with NF frequently develop septic shock and multi-organ failure. Other common complications include disseminated-intra-vascular coagulation, adult respiratory distress syndrome, acidosis and hypothermia. In addition to this patients will often have large areas of skin and subcutaneous tissue debrided at a time, resulting in a large third space loss of fluid that is difficult to quantify. Patients should be managed in a critical care setting with close cardiac output monitoring, access to inotropic support and tight glycaemic control.

• #59 Necrotizing fasciitis: strategies for diagnosis and management | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/1749-7922-2-19

  Hyperbaric oxygen therapy (HBO) treatment increase tissue oxygenation in both healthy tissue and in the vicinity of infected tissue. […] Hyperbaric oxygen-therapy was administered at 2.5 to 3.0 atmospheres for 90 min twice daily, following surgical debridement until no ongoing necrosis was evident in patients with clostridial infections. […] The mortality rates are still very high in NF due to the severe sepsis that necessitates other interventions to overcome sepsis-related mortality.

• #60 Necrotizing Fasciitis Treatment, Symptoms, Pictures, Diagnosis & Causes of Flesh-Eating Disease

  https://www.medicinenet.com/necrotizing_fasciitis/article.htm

  A surgeon needs to be consulted immediately if necrotizing fasciitis is suspected or preliminarily diagnosed. Surgical drainage and/or debridement of necrotic tissue and collection of tissue samples, needed for culture to identify the infecting organism, are done by a surgeon. The surgeon may also recommend negative pressure wound therapy (vacuum dressing to promote wound healing). […] Many patients with necrotizing fasciitis are very sick, and most require admission to an intensive care unit. Sepsis and organ failure (renal, pulmonary, and cardiovascular systems) need to be treated aggressively to increase the patient’s chance for recovery. Treatments such as insertion of a breathing tube, intravenous administration of fluids, and drugs to support the cardiovascular system may be required.

• #61 Necrotizing Fasciitis Treatment & Management: Approach Considerations, Surgical Debridement, Antimicrobial Therapy

  https://emedicine.medscape.com/article/2051157-treatment

  Once all of the affected tissues have been debrided, soft tissue reconstruction can be considered. […] Empiric antibiotics should be started immediately. […] Initial antimicrobial therapy should be broad-based, to cover aerobic gram-positive and gram-negative organisms and anaerobes. […] Successful use of intravenous immunoglobulin (IVIG) has been reported in the treatment of streptococcal toxic shock syndrome. […] Once other modalities, including surgical debridement and antibiotic administration, have been used, hyperbaric oxygen therapy (HBOT) may be considered, if available. […] The literature suggests that HBOT can reduce mortality when used as part of an aggressive treatment regimen for necrotizing fasciitis. […] A team approach is the best method of treating this complicated disorder.

• #62 The Diagnosis And Management Of Necrotising Fasciitis : Virtual Library

  https://resources.wfsahq.org/atotw/the-diagnosis-and-management-of-necrotising-fasciitis-anaesthesia-tutorial-of-the-week-298/

  Treatment of NF consists of early and aggressive debridement of necrotic tissue, together with broad-spectrum antibiotics and haemodynamic support. Treatment should be delivered by a multidisciplinary team of intensivists, microbiologists and surgeons, preferably including a plastic surgeon. […] NF is a surgical emergency and warrants immediate surgical referral. Evidence has shown that when treatment is based on just antimicrobial therapy and support, mortality approaches 100%. Surgery is a vital means of source control. The goal of surgical intervention is to aggressively debride of all the necrotic tissue until healthy, viable (bleeding) tissue is reached. […] Antibiotics are a vital adjunct to source control and may prevent the progression of septic shock when used early. In a widely quoted paper by Kumar et al effective antimicrobial administration within the first hour of documented hypotension was associated with increased survival in patients with septic shock. Furthermore, in this study which was not restricted to patients with NF, each hour of delay in administering antibiotics was associated with an average decrease in survival of 7.6%.

• #63 Necrotizing Fasciitis: Treatment and Recovery – Nursing CE Central

  https://nursingcecentral.com/lessons/necrotizing-fasciitis-treatment-and-recovery/

  Hemolytic stability will return once the necrotic tissue is removed. Amputations may be needed if the necrotic tissue is not removed. The surgical wound needs to be kept open and is usually packed with wet gauze. Daily dressing changes are needed to keep the wound clean. After the necrotic tissue is removed and the patient begins to stabilize, reconstructive surgery may be necessary. […] In some cases, the surgical wound cannot be closed, and a plastic surgeon may be consulted for reconstruction. A grafted skin flap may be needed to close the wound. This would be done in subsequent surgeries. Necrotizing fasciitis requires a multidisciplinary care team for treatment and management.

• #64 Periorbital Facial Necrotizing Fasciitis in Adults: A Rare Severe Disease with Complex Diagnosis and Surgical Treatment—A New Case Report and Systematic Review

  https://www.mdpi.com/2075-4426/13/11/1612

  In all cases from the literature, the covering of the remaining soft tissue defects post-necrectomy required various reconstructive techniques, from split-thickness skin grafts to local or distant flaps. These techniques are always selected based on the size and location of the defect, with respect, if possible, to the aesthetic units of the face, aiming for the best possible functional and aesthetic outcome. […] Given the severity of the disease, the localization, and the involvement of various anatomical regions of the face, a multidisciplinary surgical approach (involving plastic surgeons, ophthalmologists, and craniofacial surgeons) becomes necessary. In the described case, the complexity of the disease, the complications, and the patient’s comorbidities required collaboration with specialists in infectious diseases and psychiatry.

• #65 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Antimicrobial therapy for necrotizing fasciitis is as follows: Imipenem 1 g every 6 to 8 hours, daptomycin 6 mg/kg QD, and clindamycin 600 mg to 900 mg 4 times daily. […] The patient must be kept NPO (nothing by mouth) until seen by the surgeon. Nutrition is vital, but only after surgery has been completed. […] Hyperbaric oxygen therapy may be effective for small wounds, but there is no evidence that this therapy improves healing or prolongs life for large wounds. […] The patient’s recovery is faster as long as the necrotic tissue is removed. […] Only through a systemic approach with close collaboration can the mortality of this condition be lowered.

• #66 Necrotising fasciitis and septic shock: A case report of a patient receiving an immunomodulatory agent for multiple sclerosis – Wounds International

  https://woundsinternational.com/journal-articles/necrotising-fasciitis-and-septic-shock-a-case-report-of-a-patient-receiving-an-immunomodulatory-agent-for-multiple-sclerosis/

  In addition to the individual steps, the authors believe that their teams personal involvement with this patients care, involving the early involvement of a large multidisciplinary team harmonically collaborating for her care, was the major factor contributing to her recovery. […] A multidisciplinary, early and aggressive approach is fundamental for the survival of the patient.

• #67 Necrotizing Fasciitis Treatment & Management: Approach Considerations, Surgical Debridement, Antimicrobial Therapy

  https://emedicine.medscape.com/article/2051157-treatment

  Once the diagnosis of necrotizing fasciitis is confirmed, initiate treatment without delay. […] Because necrotizing fasciitis is a surgical emergency, the patient should be admitted immediately to a surgical intensive care unit in a setting such as a regional burn center or trauma center, where the surgical staff is skilled in performing extensive debridement and reconstructive surgery. […] A regimen of surgical debridement is continued until tissue necrosis ceases and the growth of fresh, viable tissue is observed. […] Prompt surgery ensures a higher likelihood of survival. […] Antibiotic therapy is a key consideration. Possible regimens include a combination of penicillin G and an aminoglycoside (if renal function permits), as well as clindamycin (to cover streptococci, staphylococci, gram-negative bacilli, and anaerobes).

• #68 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Necrotizing fasciitis is a subset of aggressive skin and soft tissue infections that cause muscle fascia and subcutaneous tissue necrosis. […] This activity reviews the evaluation, treatment, and prognosis of necrotizing fasciitis and highlights the role of an interprofessional team in evaluating and improving care for patients with this condition. […] The treatment of necrotizing fasciitis is surgery, and no time should be wasted calling for a surgical consult. The earlier the surgery is undertaken, the better the outcome. […] Key concepts for treatment/management of skin and soft-tissue infections are: Early diagnosis and differentiation between necrotizing and non-necrotizing skin and soft tissue infections, the early launch of appropriate empiric antibacterial coverage (wide-spectrum), adequate control of infection sources, such as aggressive surgical intervention for abscess drainage and debridement of NSTIs, identification of infection-causing pathogens and applicable adjustment of antimicrobial coverage.

• #69 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Necrotizing fasciitis is a subset of aggressive skin and soft tissue infections that cause muscle fascia and subcutaneous tissue necrosis. […] This activity reviews the evaluation, treatment, and prognosis of necrotizing fasciitis and highlights the role of an interprofessional team in evaluating and improving care for patients with this condition. […] The treatment of necrotizing fasciitis is surgery, and no time should be wasted calling for a surgical consult. The earlier the surgery is undertaken, the better the outcome. […] Key concepts for treatment/management of skin and soft-tissue infections are: Early diagnosis and differentiation between necrotizing and non-necrotizing skin and soft tissue infections, the early launch of appropriate empiric antibacterial coverage (wide-spectrum), adequate control of infection sources, such as aggressive surgical intervention for abscess drainage and debridement of NSTIs, identification of infection-causing pathogens and applicable adjustment of antimicrobial coverage.

• #70 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Necrotizing fasciitis is a subset of aggressive skin and soft tissue infections that cause muscle fascia and subcutaneous tissue necrosis. […] This activity reviews the evaluation, treatment, and prognosis of necrotizing fasciitis and highlights the role of an interprofessional team in evaluating and improving care for patients with this condition. […] The treatment of necrotizing fasciitis is surgery, and no time should be wasted calling for a surgical consult. The earlier the surgery is undertaken, the better the outcome. […] Key concepts for treatment/management of skin and soft-tissue infections are: Early diagnosis and differentiation between necrotizing and non-necrotizing skin and soft tissue infections, the early launch of appropriate empiric antibacterial coverage (wide-spectrum), adequate control of infection sources, such as aggressive surgical intervention for abscess drainage and debridement of NSTIs, identification of infection-causing pathogens and applicable adjustment of antimicrobial coverage.

• #71 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Necrotizing fasciitis is a subset of aggressive skin and soft tissue infections that cause muscle fascia and subcutaneous tissue necrosis. […] This activity reviews the evaluation, treatment, and prognosis of necrotizing fasciitis and highlights the role of an interprofessional team in evaluating and improving care for patients with this condition. […] The treatment of necrotizing fasciitis is surgery, and no time should be wasted calling for a surgical consult. The earlier the surgery is undertaken, the better the outcome. […] Key concepts for treatment/management of skin and soft-tissue infections are: Early diagnosis and differentiation between necrotizing and non-necrotizing skin and soft tissue infections, the early launch of appropriate empiric antibacterial coverage (wide-spectrum), adequate control of infection sources, such as aggressive surgical intervention for abscess drainage and debridement of NSTIs, identification of infection-causing pathogens and applicable adjustment of antimicrobial coverage.

• #72 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Antimicrobial therapy for necrotizing fasciitis is as follows: Imipenem 1 g every 6 to 8 hours, daptomycin 6 mg/kg QD, and clindamycin 600 mg to 900 mg 4 times daily. […] The patient must be kept NPO (nothing by mouth) until seen by the surgeon. Nutrition is vital, but only after surgery has been completed. […] Hyperbaric oxygen therapy may be effective for small wounds, but there is no evidence that this therapy improves healing or prolongs life for large wounds. […] The patient’s recovery is faster as long as the necrotic tissue is removed. […] Only through a systemic approach with close collaboration can the mortality of this condition be lowered.

• #73 Necrotizing Soft-Tissue Infection: Disease Overview and Updated Treatment Strategies

  https://www.uspharmacist.com/article/necrotizing-softtissue-infection-disease-overview-and-updated-treatment-strategies

  Nothing should delay emergent surgical debridement and antibiotic administration, as both are important in ensuring survival. […] The mortality rate associated with NSTI is as high as 30% to 70% in patients with GAS necrotizing fasciitis combined with hypotension and organ failure. […] Because treatment involves multiple visits to the OR, large wounds and possible amputations are routinely reported.

• #74 Necrotising fasciitis • LITFL • CCC

  https://litfl.com/necrotising-fasciitis/

  Extensive urgent surgical debridement (the mainstay!) […] Antimicrobial therapy […] clindamycin and lincomycin – theoretically suppress toxin production by streptococci (no clinical evidence) […] penicillin is often added but is not necessary for empiric treatment […] nosocomial infections – vancomycin to cover MRSA (plus clindamycin or lincamycin) […] Seek and treat underlying cause and complications (e.g. diabetes mellitus) […] Supportive care and monitoring […] Consults […] urgent transfer to operating theatre […] often need ICU admission post-operatively, may need further surgeries and often treated with hyperbaric oxygen […] mortality 30-40% with appropriate therapy […] increased mortality in co-morbid patients […] mortality directly proportional to delay in diagnosis and treatment.

• #75 Necrotizing Fasciitis Causes, Symptoms, and Treatments

  https://www.upmc.com/services/orthopaedics/conditions/necrotizing-fasciitis

  How Do You Treat Necrotizing Fasciitis? Doctors treat necrotizing fasciitis with surgery and medicine. Many people require multiple surgeries. […] In a procedure called „debridement,” the surgeon opens up the skin around the wound. They then remove all dead and infected tissue, along with tissue that may be infected. They thoroughly clean the area. […] Your doctor will prescribe IV antibiotics to help ensure the infection doesn’t spread to healthy tissues. […] Your doctor may prescribe intravenous immune globulin (human antibodies), which can help to fight infection. You may also need other medicines to support your lungs, heart, liver, or other organs. […] Hyperbaric oxygen, or pressurized oxygen, can speed wound healing. […] Even with treatment, about 1 in 5 people with flesh-eating disease will die from it, according to the CDC. People who survive flesh-eating disease usually have reduced function in the affected area due to the destroyed muscle tissue, nerves, and blood vessels. […] The earlier in the course of disease people seek treatment, the better their chance of survival.

• #76 Necrotizing fasciitis: treatment concepts & clinical outcomes – an institutional experience | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-024-02638-2

  Mortality was significantly lower in patients who underwent early surgical debridement than in those with a delay in surgical treatment (41% vs. 58%, p0.005). […] Early and thorough surgical debridement is the single most crucial intervention of choice in patients with NF, regardless of disease severity and the LRINEC score.

• #77 Necrotising fasciitis

  https://www.nhs.uk/conditions/necrotising-fasciitis/

  Necrotising fasciitis gets worse quickly and can be fatal. It must be treated in hospital as soon as possible. […] Treatment will usually include: antibiotics, surgery to remove the affected area. […] Even after successful treatment, there may be long-term changes in how your body looks and how you move or use the affected part of your body. Sometimes amputation of affected limbs is needed. […] You may need further surgery and physiotherapy to help you recover.

• #78 Necrotizing Fasciitis Causes, Symptoms, and Treatments

  https://www.upmc.com/services/orthopaedics/conditions/necrotizing-fasciitis

  How Do You Treat Necrotizing Fasciitis? Doctors treat necrotizing fasciitis with surgery and medicine. Many people require multiple surgeries. […] In a procedure called „debridement,” the surgeon opens up the skin around the wound. They then remove all dead and infected tissue, along with tissue that may be infected. They thoroughly clean the area. […] Your doctor will prescribe IV antibiotics to help ensure the infection doesn’t spread to healthy tissues. […] Your doctor may prescribe intravenous immune globulin (human antibodies), which can help to fight infection. You may also need other medicines to support your lungs, heart, liver, or other organs. […] Hyperbaric oxygen, or pressurized oxygen, can speed wound healing. […] Even with treatment, about 1 in 5 people with flesh-eating disease will die from it, according to the CDC. People who survive flesh-eating disease usually have reduced function in the affected area due to the destroyed muscle tissue, nerves, and blood vessels. […] The earlier in the course of disease people seek treatment, the better their chance of survival.

• #79 Necrotising fasciitis

  https://www2.hse.ie/conditions/necrotising-fasciitis/

  Necrotising fasciitis gets worse quickly and you can die from it. You must get treatment in a hospital as soon as possible. […] Treatment usually includes: antibiotics, surgery to remove the affected area. […] Even after successful treatment, there may be long-term changes to the affected part of your body. Sometimes amputation is needed. […] You may need more surgery and physiotherapy to help you recover.

• #80 Is Necrotizing Fasciitis Curable?

  https://www.glynns.co.uk/necrotising-fasciitis/is-necrotizing-fasciitis-curable.php

  Early treatment will also stop the bacteria from reaching the bloodstream and triggering a septic reaction. This will give the patient a much better chance of survival. Therefore emergency treatment is needed to avoid both short-term complications (sepsis) and long-term complications (amputation and tissue loss).

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