Necrotizing Fasciitis

What a name! Necrotizing fasciitis (NF) is the "flesh-eating" bacteria that you sometimes hear about in the news. How do people contract this horrible and sometimes fatal infection? Is it just pure, bad luck? Web MD says that "every year, between 600 and 700 cases are diagnosed in the U.S. About 25% to 30% of those cases result in death." Those are some pretty impressive statistics!

What Is It About This Flesh-Eating Bacteria?

NF is most commonly caused by Group A Streptococcus which is the same type of bacteria that causes strep throat. Despite this, there are other types of bacteria that can cause NF:

Aeromonas Hydrophila
Clostridium
E. coli
Klebsiella
Staphylococcus aureus

In order for this infection to develop, there has to be some kind of scrape or abrasion for it to enter the body. The most common routes of infection that I have seen in the ICU have been either through pimples in the groin or upper leg area, or through IV injection sites. This type of bacteria spreads very rapidly. Nurses, get your sharpie pens out to mark the borders of the infection and monitor it closely!

Signs And Symptoms

Think of what happens when someone gets has a cut that gets infected. The cut becomes red, inflamed, hot, and is increasingly painful. With NF, these symptoms are present but are more profound than seem appropriate. The pain experienced with NF will seem excessive considering the wound. The pain, swelling, and redness will continue to worsen over the first 48 hours. Patients may experience nausea, vomiting, diarrhea, and fever in addition to these symptoms. As the infection progresses, patients will exhibit symptoms of shock and hemodynamic instability.

Can I Get Necrotizing Fasciitis?

I have taken care of a variety of patients who have developed NF. It seems like some people who develop it just have bad luck. Most, however, have some kind of co-morbidity which usually includes obesity and diabetes.

“Conditions and behaviors that increase the prevalence of poly-microbial NF include obesity, chronic kidney failure, HIV, alcohol abuse, abscess, IV drug use, blunt or penetrating trauma, insect bites, surgical incisions, indwelling catheters, chicken pox, vesicles, and (rarely) perforation of the gastrointestinal tract (Sarani et al). However, everybody is susceptible to NF.”

— National Organization for Rare Disorders

Treatment

There are multiple treatment regimens for necrotizing fasciitis.

One main treatment for NF is to clean out the muscle or tissue that it has been affected. In other words, go to the OR and debride (clean) out the wound. Patients are commonly intubated (on a breathing machine) for multiple days as they go to and from the OR for wound cleaning.
Many patients have wound vacs placed which suck the extra blood or fluid coming from the wound into a canister and aid in keeping the wound clean.
In addition to removing the infection tissue, patients are also placed on intravenous antibiotic therapy. This type of infection is quite fatal especially if caught in the later phases of infection. NF usually causes the patient to become septic which requires another whole regiment of medications and treatment in itself.
Treatment can also include the use of hyperbaric oxygenation therapy.