Necrotising Fasciitis
Bacterial soft tissue infection with involvement of adjacent fascia.
History
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spreading erythema and oedema beyond margin of erythema
skin is smooth, shiny, swollen and may have bullae/feel wooden-hard
crepitus (gas gangrene)
sepsis (fever, chills, myalgia)
severe constant pain that is out of proportion to clinical findings
cutaneous anaesthesia
evidence of developing organ failures
Treatment:
1. Resuscitation if septic shock present
2. Surgical debridement
3. Antimicrobial therapy
- Empiric: Meropenem 1gQ8h/Clindamycin 600mg Q8h  b-lactam
- Clindamycin/Lincomycin 600mg Q8h  theoretical toxin suppression from
streptococci
- Vancomycin  MRSA
Meropenem
Carbapenems
Bactericidal: inhibits
peptidoglycan cross-linking n cell
synthesis
CNS coverage
Clindamycin/Lincomycin
Vancomycin
Lincosamide
bacteriostatic:
Inhibits bacterial protein
synthesis at the level of 50S
ribosome
Glycopeptide antibiotic
Bactericidal: inhibits cell wall
synthesis
Gram + and GramStreptococci,
staphylococci, Escherichia coli,
Haemophilus influenzae, Moraxella
catarrhalis, Klebsiella
pneumoniae, Bacteroides fragilis,
some strains of pseudomonas
aeruginosa
DOES not cover Stenotrophomonas
maltophilia, Burkholderia cepacia,
and Enterococcus faecium
Anaerobic gram-negative rod-shaped
bacteria and aerobic gram-positive
cocci coverage.
DOES NOT cover pseudomonas,
legionella, haemophilus influenzas,
Moraxella
Gram+ coverage
MRSA
Necrotizing fasciitis:
Subtherapeutic amounts of clindamycin may have activity against
toxin production by S aureus and toxin-producing streptococci. In in
vitro and animal models, clindamycin decreases toxin production in
necrotizing fasciitis caused by invasive group A streptococci.
Consequently, despite the lack of human data, many experts
recommend the combination of clindamycin and penicillin for severe
group A infections such as necrotizing fasciitis. Clindamycin is
recommended for this indication in Anti-Infective Guidelines for
Community-Acquired Infections as a first-line agent, together with
penicillin (8,9). Falagas and Gorbach (3), in a recent review,
recommended clindamycin together with penicillin for severe skin
and soft tissue infections due to group A streptococci or Clostridium
perfringens.