Lightning Learning: Necrotising Fasciitis
““This rare condition requires a high index of suspicion. Clinical features are progressive, but mortality can double after only 24 hours of presentation!””
STOP!
Suspect with “any soft tissue infection unresponsive to treatment with rapid deterioration.” This rare condition requires a high index of suspicion as it has devastating consequences...
Risk factors include: immunosuppression, diabetes, malnutrition, alcoholism, IV drug misuse
Trigger factors include: trauma, surgery, chickenpox (varicella), any local skin damage, omphalitis (in babies)
Important clues: it can take up to a week from the trigger to early signs (see below), after which progression is rapid
LOOK
Clinical features are progressive… mortality doubles after 24 hours of presentation!
Stage 1: erythema, swelling, warmth, TENDERNESS beyond area of affected skin
Stage 2: blisters, bullae formation, serous fluid, fluctuance and induration of the skin
Stage 3: numb, crepitus, bleeding, discolouration, necrosis progressing to gangrene
LEARN
The Top Bacterial Cause? Polymicrobial
Others? Group A haemolytic streptococci, Strep pyogenes, enterococci, E. Coli, Pseudomonas aeruginosa, Clostridium sp. & more.
Investigations?
FBC, CRP, U&Es, LFTs, Clotting and blood cultures
XR/USS imaging may help
Immediate Management?
CALL THE SURGEONS for urgent consult +/- surgical debridement (definitive treatment)
IV Antibiotics Broad beta-lactam or Carbapenem + clindamycin + vancomycin, NB: check local policy
Treat shock and deranged electrolytes as necessary
