A Review on Current Trend in the Management of Necrotizing Fasciitis

Abstract

Necrotizing fasciitis an inflammatory and infectious disease condition affecting the fascia with the secondary involvement of soft tissues and skin. This infection is associated with progressive necrosis of any of the layers in the soft tissue compartment. The infection is commonly polymicrobial and sometimes methicillin resistant staphylococcal infection. It affects various parts of the body in males, females and paediatric age groups. It is a worldwide disease of public health concern and the mortality rate could be up to 100% if not diagnosed and treated early. It is classified based on the causative microorganisms and part of the body affected. There are four important types based on microbiological classification as follows; 1) Type 1 necrotizing fasciitis (polymicrobial infection), 2) type 2 (Monomicrobial Gram-positive organisms), 3) type 3 (Gram-negative monobacteria typically marine-related organisms). 4) Type 4 (Fungal infection). The diagnosis of necrotizing fasciitis comprises of multidisciplinary approach to include Microbiologists, Histopathologists, as well as Medical and Surgical teams. The clinical evaluation of the patient and laboratory analysis of the samples obtained from the wound site, will guide for appropriate treatment of the infection. The management includes immediate resuscitation of the patient, early administration of broad-spectrum parenteral antibiotics to cover for gram-positive, gram-negative, aerobes and anaerobic organisms such as cephalosporins, penicillins, quinolones, vancomycin, clindamycin and metronidazole. Empirical antibiotic treatment is considered before the result of culture and sensitivity is out Aggressive wound debridement in theatre provides a favourable outcome.