Necrotizing fasciitis: treatment concepts and clinical results

• Published in: European journal of trauma and emergency surgery (Munich : 2007) Vol. 44; no. 2; pp. 279 - 290
• Main Authors: Leiblein, M., Marzi, I., Sander, A. L., Barker, J. H., Ebert, F., Frank, J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2018; Springer Nature B.V
• Subjects: Adult; Amputation; Amputation - statistics & numerical data; Antibiotics; Critical Care Medicine; Debridement - statistics & numerical data; Diabetes; Diabetes Mellitus, Type 2 - complications; Emergency Medicine; Fasciitis, Necrotizing - complications; Fasciitis, Necrotizing - epidemiology; Fasciitis, Necrotizing - etiology; Fasciitis, Necrotizing - surgery; Female; Germany - epidemiology; Health risk assessment; Humans; Intensive; Intensive care; Male; Medicine; Medicine & Public Health; Necrotizing fasciitis; Original Article; Penicillin; Retrospective Studies; Sports Medicine; Surgery; Surgical Orthopedics; Traumatic Surgery; Hemolytic streptococcal gangrene; Necrotizing cellulites; Soft tissue infection; Necrotizing fasciitis
• ISSN: 1863-9933; 1863-9941
• DOI: 10.1007/s00068-017-0792-8

Background Necrotizing fasciitis is a life-threatening soft tissue infection characterized by a rapid spreading infection of the subcutaneous tissue and in particular the fascia. The management of infected tissues requires a rapid diagnosis, immediate aggressive surgical management and an extended debridement. In some cases early amputations of the affected tissues and maximum intensive care treatment, in case of sepsis, are required. Due to a rising number of cases we aimed to evaluate our patients in a retrospective review. Method All patients diagnosed with necrotizing fasciitis from 2014 to 2016 (21 months) in our level one trauma center were identified. Their charts were reviewed and data were analyzed in terms of demographic and social information, microbiological results, therapeutic course, socio-economic outcome and mortality. Results We found 15 patients with necrotizing fasciitis. None of these died in the observation period. The mean number of surgical interventions was seven. Two patients underwent limb amputation; diabetes mellitus was assigned with a significant higher risk for amputation. The mean hospitalization was 32 days, including 8 days on intensive care unit. Of the discovered bacteria 93% were sensitive to the initial antibiotic treatment with Ampicillin, Clindamycin and Clont. Conclusion Surgical therapy is indicated if necrotizing fasciitis is suspected. Diabetes mellitus was a clinical predictor of limb amputation in patients with necrotizing fasciitis in our cohort. Aminopenicillin ± sulbactam in combination with clindamycin and/or metronidazole is recommended as initial calculated antibiotic treatment.