Necrotizing Fasciitis (cont.)
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Necrotizing fasciitis (flesh-eating disease) facts
- What is necrotizing fasciitis?
- Are there different types of necrotizing fasciitis?
- What causes necrotizing fasciitis?
- Who is at risk to get necrotizing fasciitis?
- What are necrotizing fasciitis symptoms and signs?
- How do health-care professionals diagnose necrotizing fasciitis?
- What types of doctors treat necrotizing fasciitis?
- What is the treatment for necrotizing fasciitis?
- Is it possible to prevent necrotizing fasciitis? Is necrotizing fasciitis contagious?
- What is the prognosis (outcome) for patients with necrotizing fasciitis? What are complications of necrotizing fasciitis?
- What are some additional sources of information on necrotizing fasciitis?
What is the treatment for necrotizing fasciitis?
At the time of preliminary diagnosis, the patient needs to be hospitalized and started on intravenous (IV) antibiotics immediately. The initial choice of antibiotics can be made based upon the types of flesh-eating bacteria suspected of causing the infection, but many doctors believe that multiple antibiotics should be used at the same time to protect the patient from methicillin-resistant Staphylococcus aureus (MRSA, or sometimes termed flesh-eating bacteria in the popular press), as well as infections with anaerobic bacteria, and polymicrobial infections. Antibiotic susceptibility studies, done in the laboratory after the infecting organism(s) has been isolated from the patient, can help the physician choose the best antibiotics to treat the infected individual.
A surgeon needs to be consulted immediately if necrotizing fasciitis is suspected or preliminarily diagnosed. Surgical drainage and/or debridement of necrotic tissue and collection of tissue samples, needed for culture to identify the infecting organism, are done by a surgeon. The surgeon may also recommend negative pressure wound therapy (vacuum dressing to promote wound healing). The type of surgeon consulted may depend on the area of the body affected; for example, a urologic surgeon would be consulted for Fournier's gangrene. As is the case for immediate antimicrobial therapy, early surgical treatment of most cases of necrotizing fasciitis can reduce morbidity and mortality.
Many patients with necrotizing fasciitis are very sick, and most require admission to an intensive-care unit. Sepsis and organ failure (renal, pulmonary, and cardiovascular systems) need to be treated aggressively to increase the patient's chance for recovery. Treatments such as insertion of a breathing tube, intravenous administration of fluids, and drugs to support the cardiovascular system may be required. Although not available in many hospitals, hyperbaric oxygen therapy (oxygen given under pressure with the patient in a specialized chamber) is sometimes used in treatment as the oxygen can inhibit or stop anaerobic bacterial growth and promote tissue recovery. This therapy does not replace antibiotics or surgical treatment. However, hyperbaric oxygen therapy has been shown by researchers to further reduce morbidity and mortality by about 10%-20% in some patients when used in conjunction with antibiotics and surgery. Some patients have such extensive damage to limbs that they require skin grafting, plastic surgery, or even amputation.
The duration of treatment for necrotizing fasciitis is highly variable and often depends upon the extent of the disease and how well the patient responds to treatments. Patients with extensive disease may take months of treatment especially if they need skin grafting and/or plastic surgery.
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