Necrotising Fasciitis

Question 1

How is a systemic inflammatory response defined?

Answer 1

2 or more of:
Temperature >38 or <36
Tachycardia >90bpm
Tachpnoea RR>20/min
WBC >12x10^9/L

Question 2

What is the cause of class one necrotising fasciitis?

Answer 2

Synergistic infection with anaerobes (e.g. bacterioides) and robes (streptococci, eneterobacteriaciae)
More common in elderly diabetic patients

Question 3

What is the cause of class two necrotising fasciitis?

Answer 3

Infection with group A streptococci mediated with toxin production

Question 4

What is the cause of type three necrotising fasciitis?

Answer 4

Vibrio vulnificus after trauma in sea water

Question 5

What is the cause of type four necrotising fasciitis?

Answer 5

Fungal infection

Question 6

Very broad cover is required for the treatment of necrotising fasciitis. What antibiotics are commonly used?

Answer 6

IV flucloxacillin (for staph coverage)
IV benzylpenicllin (for strep coverage)
IV gentamicin (for gram negative coverage)
IV metronidazole (for anaerobes coverage)
PO/IV clindamycin (for anaerobes/reduction in toxin production)

Question 7

How is necrotising fasciitis treated surgically?

Answer 7

Radical debridement of the infected and necrotic tissue