6.5. Skin and Soft Tissue Infection - Necrotising Fasciitis

Question 1

Is Necrotising Fasciitis an emergency?

Answer 1

Yes, it is one of the infectious disease emergencies

Question 2

Where can be affected by Necrotising Fasciitis?

Answer 2

Any site

Question 3

What are the predisposing conditions to Necrotising Fasciitis?

Answer 3

1. Diabetes Mellitus
2. Surgery
3. Trauma
4. Peripheral Vascular Disease
5. Skin Popping

Question 4

How many types of Necrotising Fasciitis are there?

Answer 4

2

Question 5

What are the types of Necrotising Fasciitis?

Answer 5

1. Type 1 Necrotising Fasciitis

2. Type 2 Necrotising Fasciitis

Question 6

What defines Type 1 Necrotising Fasciitis?

Answer 6

Mixed Aerobic and Anaerobic infection (Diabetic Foot infection, Fournier’s Gangrene)

Question 7

What are common organisms in Type 1 Necrotising Fasciitis?

Answer 7

1. Streptococci
2. Staphylococci
3. Enterococci
4. Gram Negative Bacilli
5. Clostridium

Question 8

What defines Type 2 Necrotising Fasciitis?

Answer 8

It is monomicrobial, normally associated with Streptococcal Pyogenes

Question 9

What are the Symptoms of Necrotising Fasciitis?

Answer 9

1. Rapid Onset
2. Sequential development of Erythema, Oedema, and Severe, unremitting pain
3. Haemorrhagic Bullae, Skin Necrosis and Crepitus may develop
4. Systematic Features (Fever, Hypotension, Tachycardia, Delirium, Multi-organ failure)
   Note - Anaesthesia at the site of infection is highly suggestive of this disease

Question 10

What is mandatory in treating Necrotising Fasciitis?

Answer 10

Surgical Review

Note - imaging may help but could delay treatment

Question 11

What antibiotics should be used to treat Necrotising Fasciitis?

Answer 11

Broad Spectrum:

1. Flucloxacillin
2. Gentamicin
3. Clindamycin

Question 12

What is the overall mortality range of Necrotising Fasciitis?

Answer 12

17-40%