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Necrotising fasciitis

Necrotising fasciitis

Necrotising fasciitis is a medical emergency that is difficult to recognise in the early stages.

It can be classified according to the causative organism:
  • type 1 is caused by mixed anaerobes and aerobes (often occurs post-surgery in diabetics). This is the most common type
  • type 2 is caused by Streptococcus pyogenes

Risk factors
  • skin factors: recent trauma, burns or soft tissue infections
  • diabetes mellitus
    • the most common preexisting medical condition
    • particularly if the patient is treated with SGLT-2 inhibitors
  • intravenous drug use
  • immunosuppression

The most commonly affected site is the perineum (Fournier's gangrene).

Features
  • acute onset
  • pain, swelling, erythema at the affected site
    • often presents as rapidly worsening cellulitis with pain out of keeping with physical features
    • extremely tender over infected tissue with hypoaesthesia to light touch
    • skin necrosis and crepitus/gas gangrene are late signs
  • fever and tachycardia may be absent or occur late in the presentation

Management
  • urgent surgical referral debridement
  • intravenous antibiotics

Prognosis
  • average mortality of 20%
+PassMedicine Notes

Necrotising fasciitis is a medical emergency that is difficult to recognise in the early stages.

It can be classified according to the causative organism:
  • type 1 is caused by mixed anaerobes and aerobes (often occurs post-surgery in diabetics). This is the most common type
  • type 2 is caused by Streptococcus pyogenes
Risk factors
  • skin factors: recent trauma, burns or soft tissue infections
  • diabetes mellitus
    • the most common preexisting medical condition
    • particularly if the patient is treated with SGLT-2 inhibitors
  • intravenous drug use
  • immunosuppression

The most commonly affected site is the perineum (Fournier's gangrene).

Features
  • acute onset
  • pain, swelling, erythema at the affected site
    • often presents as rapidly worsening cellulitis with pain out of keeping with physical features
    • extremely tender over infected tissue with hypoaesthesia to light touch
    • skin necrosis and crepitus/gas gangrene are late signs
  • fever and tachycardia may be absent or occur late in the presentation
Management
  • urgent surgical referral debridement
  • intravenous antibiotics
Prognosis
  • average mortality of 20%


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