Necrotizing Fasciitis (cont.)
How is necrotizing fasciitis treated?
At the time of preliminary diagnosis, the patient needs to be hospitalized and started on intravenous antibiotics immediately. The initial choice of antibiotics can be made based upon the types of bacteria suspected of causing the infection, but many doctors believe that multiple antibiotics should be used at the same time to protect the patient from methicillin-resistant
Staphylococcus aureus (MRSA), as well as infections with anaerobic bacteria, and polymicrobic infections. Antibiotic susceptibility studies, done in the laboratory after the infecting organism(s) has been isolated from the patient, can help the physician choose the best antibiotics to treat the infected individual.
A surgeon needs to be consulted immediately if necrotizing fasciitis is suspected or preliminarily diagnosed. Debridement of necrotic tissue and collection of tissue samples, needed for culture to identify pathogens, are done by a surgeon. The type of surgeon consulted may depend on the area of the body affected; for example, a urologic surgeon would be consulted for Fournier's gangrene. As is the case for immediate antimicrobial therapy, early surgical treatment of most cases of necrotizing fasciitis can reduce morbidity and mortality.
Many patients with necrotizing fasciitis are very sick and require admission to an intensive care unit. Sepsis and organ failure (renal, pulmonary, and cardiovascular systems) need to be treated aggressively to increase the patient's chance for recovery. Treatments such as insertion of a breathing tube, intravenous administration of fluids, and drugs to support the cardiovascular system may be required. Although not available in many hospitals, hyperbaric oxygen therapy (oxygen given under pressure with the patient in a chamber) is sometimes used in treatment as the oxygen can inhibit or stop anaerobic bacterial growth and promote tissue recovery. This therapy does not replace antibiotics or surgical treatment. However, hyperbaric oxygen therapy has been shown by researchers to further reduce morbidity and mortality by about 10%-20% in some patients when used in conjunction with antibiotics and surgery.
Next: How is necrotizing fasciitis prevented? Is it contagious? »
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