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Anaerobic and Necrotizing Infections

Jonathan Andrew McKenzie, MD, MBA and Elizabeth Fox Reviewed 05/2023
 


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)...

DIAGNOSIS

  • The most consistent finding is pain out of proportion to exam findings.

  • Early recognition and immediate initiation of treatment are key.

  • Most cases exhibit swelling and erythema.

HISTORY

  • Only 10...

TREATMENT

GENERAL MEASURES

  • Prompt surgical intervention for patients with signs of systemic toxicity or suspicion of necrotizing fasciitis

  • Broad empiric antibiotic coverage

  • Penicillin plus clindamycin is...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • May require ICU care

  • Monitor for clinical signs indicating need for repeated debridement.

  • Administer antibiotic therapy until debridement is no lo...

REFERENCES

1
Gelbard  R, Ferrada  P, Yeh  DD, et al. Optimal timing of initial debridement for necrotizing soft tissue infection: a practice management guideline from the Easter...

ADDITIONAL READING

Hoesl V, Kempa S, Prantl L, et al. The LRINEC score—an indicator for the course and prognosis of necrotizing fasciitis? J Clin Med. 2022;11(13):3583.  

CODES

ICD10

  • M72.6 Necrotizing fasciitis

  • L03.90 Cellulitis, unspecified

  • A48.0 Gas gangrene

  • N49.3 Fournier gangrene

SNOMED

  • 52486002 Necrotizing fasciitis (disorder)

  • 128045006 cellulitis (disorder)

  • 80466000 Gas ...

CLINICAL PEARLS

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

  • Consider NSTI in patients with pain out of proportion to physical exam.

  • NSTI are a medica...

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