Necrotizing Fasciitis: Epidemiology, Diagnosis and Management

Abstract

Necrotizing fasciitis (NF) which rank among the more difficult disease processes encountered by physicians and surgeons is a subset of the aggressive skin and soft tissue infections that cause necrosis of the muscle fascia and subcutaneous tissues. NF are typically caused by toxin producing bacteria and now fungal agents are also emerging as one of the cause. Once symptoms initiate, the progression of disease is typically measured in hours; early diagnosis and treatment are crucial to survival. Diagnosis is hindered by the fact that the disease progresses below the surface and the cutaneous manifestations mask the severity of disease. As the infection disseminates, patients develop pain and signs of systemic toxicity disproportionate to the findings of skin examination, and physicians must maintain a high index of suspicion to rapidly diagnose NF. The standard treatment consists of broad-spectrum antibiotics, wide surgical debridement, and supportive care. Even with optimal treatment at first visit many patients require multiple surgical debridements and prolonged hospitalizations. NF is a serious disorder that carries a mortality rate of anywhere from 30 to 90%. The mortality ultimately depends on patient age, type of organism, the speed of diagnosis and treatment and patient comorbidity.

In this review, we discuss the epidemiology, etiology and pathogenesis of disease; summarize the major updates in microbiology; and elaborate the clinical presentation and diagnosis of disease. Finally, we summarize and close with the major and novel treatment strategies, organized by phase of treatment and with special emphasis on the importance of multidisciplinary care teams and hospital outcomes.