Necrotizing Fasciitis

Question 1

What are some risk factors for necrotizing faciitis?

Answer 1

1) Immune suppression (AIDS, cancer, DM)
2) Bacterial introduction
3) Obesity, chronic liver disease

Question 2

What is the most common type of necrotizing fasciitis?

Answer 2

Type 1 Polymicrobial (80-90%), usually 4-5 organisms (aerobic/anaerobic), common in abdomen and perineal area of sicker patients
Type 2Group-A beta-hemolytic strep is the most common organism isolated, common in extremities, healthy patients
Type 3 is marine vulnificus
Type 4 is MRSA

Question 3

What is the LRINEC scoring system for necrotizing fasciitis?

Answer 3

score > 6 has PPV of 92% of having necrotizing fasciitis
1) CRP (mg/L) ≥150: 4 points
2) WBC count (×103/mm3)
  25: 2 points
3) Hemoglobin (g/dL)
  >13.5: 0 points
  11–13.5: 1 point
  141: 2 points
6) Glucose (mmol/L) >10: 1 point

Question 4

What is the initial management for necrotizing fasciitis?

Answer 4

Emergent radical debridement with amputation if necessary and broad spectrum IV abx;
start on clindamycin, metronidazole, PCN and gentamicin
Can add vanc if suspect MRSA

Question 5

What is the presentation of necrotizing fasciitis?

Answer 5

Rapid progression of abscess or cellulitis, pain swelling, ecchymosis, bullae, subcutanoues gas (if gas producing organism) and unstable vitals (tachy, hypotensive, febrile)

Question 6

Poor outcomes with necrotizing fasciitis have been associated with what factor?

Answer 6

Delay in diagnosis; mortality rate of 20-30%, mortality rate correlates with time to surgical intervention,