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Anaerobic and Necrotizing Infections

Jaine McKenzie, MD and Caleb J. Mentzer, DO Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Necrotizing soft tissue infections (NSTI) are rare and rapidly progressing infections involving any layer of soft tissue including skin, subcutaneous fat, fascia, and/or muscle (1).

  • N...

DIAGNOSIS

HISTORY

  • Only 10–40% of patients present with recent history of trauma (3).

  • Inquire about history of trauma, burns, cellulitis, infection, recent surgery, IV drug use.

  • Symptoms often progress ra...

TREATMENT

GENERAL MEASURES

  • Prompt and wide surgical débridement is the cornerstone of treatment.

  • Broad-spectrum antibiotics should be administered once diagnosis of NSTI is suspected.

  • Resuscitation for t...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • May require ICU care

  • Monitor for clinical signs indicating need for repeated débridement.

  • Antibiotic therapy should be administered until further ...

REFERENCES

1
Gelbard R, Ferrada P, Dante D, et al. Optimal timing of initial debridement for necrotizing soft tissue infection: a practice management guideline from the Eastern Association for the Surg...

ADDITIONAL READING

  • Kao LS, Lew DF, Arab SN, et al. Local variations in the epidemiology, microbiology, and outcome of necrotizing soft-tissue infections: a multicenter study. Am J Surg.  2011;202...

CODES

ICD10

  • M72.6 Necrotizing fasciitis

  • L03.90 Cellulitis, unspecified

  • A48.0 Gas gangrene

  • N49.3 Fournier gangrene

ICD9

  • 728.86 Necrotizing fasciitis

  • 682.9 Cellulitis and abscess of unspecified sites

  • 040.0 Gas ...

CLINICAL PEARLS

  • NSTI are associated with potentially life-threatening, rapidly progressive, widespread necrosis.

  • Consider necrotizing soft tissue infection in patients with pain out of proportion to ph...

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