Resident Report

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Resident Report. 7/26/2011. Left Lower Leg. Necrotizing fasciitis. First described by Hippocrates in 5 th centry as a complication from erysipelas - PowerPoint PPT Presentation

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  • 7/26/2011

  • Left Lower Leg

  • First described by Hippocrates in 5th centry as a complication from erysipelas"...the erysipelas would quickly spread widely in all directions. Flesh, sinews and bones fell away in large quantities...Fever was sometimes present and sometimes absent...There were many deaths. The course of the disease was the same to whatever part of the body it spread."NECROTIZING FASCIITIS

  • Incidence (low end) 500-1000 per year nationallyPredisposing factors immunosuppression, DM, malignancy, drug abuse (IVDU), CKD50% of patients have hx of skin injury25% have blunt trauma70% have one ore more chronic illnessesNECROTIZING FASCIITIS

  • Systemic signs fever, tachycardia, hypotensionNF more commonly seen in extremities; can be seen on any part of bodyOther findings include erythema, induration, tenderness, fluctuance, skin necrosis and bullaePHYSICAL DIAGNOSIS

  • LeukocytosisElevated BUN and CrElevated CKElevated CRPHyponatremia commonly seenLAB FINDINGS

  • Type I Polymicrobial infection with aerobic and anaerobic bacteria; tends to affect the chronically ill DM, immuncompromised, etc.

    Type II Tends to be Group A Strep and can affects people indiscriminatelyNECROTIZING FASCIITIS

  • Implicated organismsGroup A StrepS. aureusA. hydrophilaE. coliKlebsiellaClostridium perfringensVibrio vulnificus


  • Immediate surgical consult

    If you suspect Type I Ampicillin/Sulbactam + Clinda/MetronidazoleCan substitute Piperacillin/Tazobactam for Amp/Sul

    If you suspect Type IIClindamycin and/or Penicillin Vancomycin in areas where community-acquired MRSA is prevalentTREATMENTS

  • Understand the signs and symptoms that make one suspect necrotizing fasciitisGet appropriate specialists involved quickly Surgery, IDRecognize higher risk of chronically ill patients to get this diseaseKnow causative organisms and treatments