Guidelines
Necrotizing Fasciitis

Necrotizing Fasciitis

Infection Control

Droplet/contact precautions until 24 hours of appropriate antimicrobial coverage received

Report cases of invasive Group A Streptococcus (iGAS) to Public Health immediately, and for possible prophylaxis in close contacts

Diagnostic Considerations

Medical emergency: surgical debridement and broad-spectrum IV antibiotics required

Immediately consult plastic surgery and infectious disease for all patients

Usually rapidly progressive with pain out of proportion to appearance

Consider need for tetanus prophylaxis

Common Pathogens

May be polymicrobial or monomicrobial

Gram negative bacilli

Anaerobes (including Clostridium species)

Empiric Treatment Infants and Older Children

AND

Clindamycin is added for antitoxin effect until patient stabilized

+/-

If clinically unstable or suspected/confirmed MRSA

Empiric Treatment in Penicillin Allergic Patients

AND

Clindamycin is added for antitoxin effect until patient stabilized

+/-

If clinically unstable or suspected/confirmed MRSA

For Treatment of Confirmed Group A Streptococcus (GAS)

AND

Clindamycin is added for antitoxin effect until patient stabilized

Select cases of invasive GAS may benefit from immunoglobulin (IVIG).

Consult ID for advice.

Report cases of invasive Group A Streptococcus to Public Health immediately for consideration of close contact prophylaxis

Duration of Therapy

Duration dependent on surgical debridement and clinical evolution