Guidelines
Suspected Necrotizing Fasciitis

Suspected Necrotizing Fasciitis

Note

Necrotizing fasciitis is considered a surgical emergency

Urgent Consults

  • Surgical consultation required: General, Orthopaedics, and/or Plastics
  • Infectious Diseases consult

Consider ICU consult

Signs & Symptoms

  • Pain out of proportion to clinical findings
  • Rapid progression
  • Gas in tissues (i.e., crepitus on exam)
  • Overlying tissue necrosis
  • Reduced sensation over affected area
  • Severe sepsis/septic shock

Microbiology

Based on microbiology 2 types have been defined. Clinically it is challenging to distinguish these, although Type II more often involves the limbs.

  • Polymicrobial infection involving Gram positive and Gram negative aerobes plus anaerobes
  • Monomicrobial infection involving Group A Streptococcus (Streptococcus pyogenes)
  • Also occurs with Groups B, C and G Streptococcus
  • Less often Staphylococcus aureus

Additional Information

Guideline originally sourced from Saskatchewan Health Authority - Saskatoon Area and adapted by Joseph Brant Hospital

  • Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America [published correction appears in Clin Infect Dis. 2015 May 1;60(9):1448. Dosage error in article text]. Clin Infect Dis. 2014;59(2):e10-e52.

  • Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Front Surg. 2014;1:36. Published 2014 Sep 29.

  • The Johns Hopkins University (2020) John Hopkins ABX Guide (1.27) [Mobile App] Retrieved from: www.hopkinsguides.com

  • Antimicrobial Therapy Inc (2020) The Sanford Guide (4.2) [Mobile App] Retrieved from: www.sanfordguide.com/

Approved June 2020