Serious soft tissue infections

Question 1

What is necrotising fasciitis?

Answer 1

A life-threatening infection of the muscle fascia and overlying sub-cut fat. Infection spreads along the fascia due to it’s poor blood supply.

Question 2

What are the two types of necrotising fasciitis?

What organisms are most commonly involved in each?

Answer 2

Type I: Polymicrobial - Anaerobes (Bacteroides, Clostridium along with a Gram -ve (PEEK = proteus, enterobacter, E.Coli, Klebsiella) and an anaerobic Streptococcus (GAS).

Type II: Monomicrobial - Usually GAS or or other beta haemolytic Strep. Also S. aureus. Less frequently vibrio (salt water) or aeromonas (fresh water).

Question 3

What % of Type II Nec Fasc cases have a clear portal of entry?

Where do the other infections come from?

Answer 3

• 50%
• GAS from translocation of bacteria in the throat -> seed to blunt force injured muscle or muscle strained region.

Question 4

What bacterial infections are the most common cause of sepsis in the first 3days of life?

Answer 4

1. Lysteria
2. GBS
3. E.Coli

Question 5

What bacterial infections are the most common cause of sepsis in the post-discharge neonate?

Answer 5

• Strep Pnemo
• HiB
• Staph aureus

Question 6

List 6 RFs for neonatal sepsis.

Answer 6

1. Low birth-weight (<2.5kg)
2. Prematurity (<37wks)
3. PROM
4. Septic or traumatic labour
5. Fetal hypoxia
6. Maternal peripartum infection
7. Galactosemia