Necrotizing Fasciitis

Necrotizing fasciitis is a type of bacterial skin infection which predominantly affects the skin but may also expand to include the subcutaneous tissue, muscle and fat. The medical term "necrosis" actually refers to the death of the body's cells or tissues. Essentially, necrotizing fasciitis results in the destruction of the cellular makeup of the skin and subcutaneous tissue. For this reason, necrotizing fasciitis is often referred to as a flesh-eating bacterial infection, because the bacteria literally eats through the layers of skin.

Causes of Necrotizing Fasciitis

Although in rare instances necrotizing fasciitis may be caused by certain strains of fungi, the condition typically occurs as the result of some type of bacterial infection. The most common strains of bacteria known to cause necrotizing fasciitis are group A streptococci and staphylococci. However, it is important to note that when the wound is cultured, other types of bacteria may be found, including non-aerobic organisms like E. coli, klebsiella and pseudomonas. Many medical scientists have concluded that non-aerobic bacteria are capable of damaging the tissues to the extent that oxygen to the area is significantly decreased, which then gives aerobic organisms like streptococci and staphylococci the opportunity to reproduce and expand.

Who Is at Risk

Although necrotizing fasciitis is somewhat rare, recent studies have indicated that about 25 percent of patients die from the progression of the condition. It is important to be aware of the risk factors for necrotizing fasciitis. In general, patients with immune deficiency disorders like diabetes, cancer and kidney disease have a much greater risk for developing necrotizing fasciitis because of the compromised state of the immune system. In addition, it is important to note that steroids are considered an immunocompromising agent; patients taking steroids for various different medical conditions should be aware of the elevated risk factor this causes.

The primary method of transfer for bacteria causing necrotizing fasciitis is through the skin. This means that open wounds are of particular concern for transmission. Wounds like bedsores and postsurgical incisions will increase a patient's risk for developing necrotizing fasciitis.

Treatment Options for Necrotizing Fasciitis

Because of the serious risk that necrotizing fasciitis presents, patients with this condition will be hospitalized immediately after the initial diagnosis is made. Intravenous antibiotics are started as coverage treatment until culture results can determine exactly which type of bacteria has caused the infection. Until the organism is determined, broad-spectrum antibiotics are typically used to cover an array of bacteria and to help reduce the risk of a methicillin-resistant staphylococcus aureus (MRSA) infection from developing. Once the culture results are available and the susceptibility of the organism has been determined, the patient will be switched to an antibiotic aimed at eradicating that particular organism.

Most patients with necrotizing fasciitis will need to undergo debridement. This is a surgical procedure which is used to remove the dead tissue. The purpose of this procedure is to help reduce the risk of secondary infection from dead tissue, as well as to reduce the ability of the bacteria to spread and create a more critical condition.

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