Recent Advances in the Treatment of Necrotizing Fasciitis

Abstract

With four types of necrotizing fasciitis (NF) now recognized, the diagnosis and management of NF becomes more challenging as physicians face more unusual pathogenic and atypical presentations. With few published guidelines and little evidence base to justify therapies, much of the literature is pragmatic or provides limited evidence with small underpowered studies and disparate case reports.

Intravenous antibiotics used in dermatology

“…coli, Pseudomonas spp., Bacteriodes spp.) (49). These infections can result after any type of bowel trauma, and are more likely to occur in the immunocompromised population (47).…”

“…When using clindamycin, a D ‐test is recommended if erythromycin resistance is demonstrated to predict inducible clindamycin resistance (60). When MRSA is suspected, vancomycin, linezolid, or daptomycin should be added (49).…”

“…type I NF comprises the majority of NF cases (47,48), and is caused by a mixture of aerobes, anaerobes, and facultative anaerobes, or more generally bowel flora (E. coli, Pseudomonas spp., Bacteriodes spp.) (49). These infections can result after any type of bowel trauma, and are more likely to occur in the immunocompromised population (47).…”

“…Type II NF originates from organisms on the skin or upper respiratory tract. GASNF typically affects a younger population than type I NF; an athlete with severe, progressive pain and systemic symptoms after a minor injury is the classic presentation (49). Elderly individuals with multiple comorbidities who are prone to having lower extremity trauma and infection are at risk for developing NF from both GAS and S. pneumoniae (51).…”

Necrotizing fasciitis arisen from nose

“…Immediate surgical debridement of the necrotic tissue and administration of broad-spectrum IV antibiotics are crucial to prevent associated mortality. Facial NF mostly originates from dental or pharyngeal abscess and radiotherapy [1,2]. However, unlike other anatomic sites facial region is rarely affected to NF with the aid of their rich vascular supply [3].…”