Necrotising fasciitis

Necrotising fasciitis may occur in anyone, in fact, almost half of all known cases of streptococcal necrotising fasciitis have occurred in young and previously healthy individuals. Necrotising soft tissue infections are a group of serious infections; necrotising fasciitis, synergistic gangrene, clostridial myonecrosis and gangrenous cellulitis; caused by a variety of micro-organisms.

Empirical therapy must be comprehensive and cover all likely pathogens, including aerobes and anaerobes and must always be an adjunct to and not a substitute for surgery. A broad-spectrum beta-lactam antibiotic should be used, together with an antibiotic that is active against anaerobes.

Misdiagnosis is very common, which, in light of the speed and deadliness of the infection, often has severe consequences, such as multiple limb amputation and too often, death. In post-surgical patients, NF often mimics common post-operative symptoms such as severe pain, inflammation, fever and nausea, which also thwarts a timely diagnosis.

Aminoglycoside blood levels must be monitored, particularly in the elderly, if high doses are used, if the patient has renal impairment, or if treatment is prolonged beyond seven days.