Anaerobic and Necrotizing Infections

Jaine McKenzie, MD and Caleb J. Mentzer, DO Reviewed 06/2017
 


BASICS

DESCRIPTION

  • Necrotizing infections of the skin and fascia—necrotizing cellulitis and necrotizing fasciitis (NF)

  • NF is a rapidly spreading and potentially fatal infection in the fascia, with secon...

DIAGNOSIS

HISTORY

  • Symptoms often progress rapidly (over hours), requiring high index of suspicion, particularly if there are no clear risk factors.

    • Malaise

    • Anorexia

    • Fever

    • Rapidly spreading skin lesions

    • Fo...

TREATMENT

GENERAL MEASURES

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

  • Hyperbaric oxygen (HBO) has been used as an adjunct to antibiotics and surgical débridement.

    • HBO therapy...

ONGOING CARE

FOLLOWUP RECOMMENDATIONS

MONITORING

  • May require ICU care

  • Monitor for clinical signs indicating need for repeated débridement.

  • Antibiotic therapy should be administered until further débrideme...

REFERENCES

Lancerotto L, Tocco I, Salmaso R et al. Necrotizing fasciitis: classification, diagnosis, and management. J Trauma Acute Care Surg.  2012;72(3):560–566. [View Abstract on OvidInsights...

ADDITIONAL READING

  • Carapetis JR, Jacoby P, Carville K et al. Effectiveness of clindamycin and intravenous immunoglobulin, and risk of disease in contacts, in invasive group A streptococcal infections....

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 ...

PEARLS

  • Necrotizing infections are associated with potentially life-threatening, rapidly progressive, widespread fascial necrosis.

  • NF may be mono- or polymicrobial.

  • Consider necrotizing soft tissue infec...

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