Necrotizing Fasciitis Explained

August 6th, 2012  |  The Blog

Necrotizing fasciitis has recently received a lot of press after a graduate student attending the University of West Georgia contracted the infection from a wound sustained in a zip-lining accident. The young woman was close to death, but she’s now recovered enough to be discharged from the hospital and begin the long road to recovery.

Let’s Talk About the Particulars

Commonly called flesh-eating bacteria, necrotizing fasciitis is a serious infection caused by bacteria. While the most common bacterium is Streptococcus pyrogenes, there are a variety of other potential culprits. The aforementioned case at the University of West Georgia was caused by Aeromonas hydrophila.

With necrotizing fasciitis, an infection starts in the tissue just below the skin and spreads along the flat layers of tissue, called fascia, which separate the muscle and fat layers. The infection causes toxins to develop, which totally destroy and kill the surrounding skin, muscle and fat.

Causes and Risk Factors

Note that most people who develop this infection have been otherwise health until this point. Patients with chronic medical conditions like cancer, diabetes, liver disease, kidney disease, those with a compromised immune system or patients taking steroids regularly are at a higher risk of developing this infection.

An open wound, cut or break in the skin is the usual point of entry for the bacteria. The wound can be the result of surgery, a recent injury, a rash-causing viral infection like chickenpox, a burn or an insect bite to name a few. Wounds that are exposed to ocean water, raw saltwater fish, oysters and crabs are more susceptible to necrotizing fasciitis. A bruise or muscle strain, even without a break in the skin, raises the risk of infection because of the underlying tissue damage.

Treating a patient with necrotizing fasciitis increases the risk for the caregiver, especially if they have an open cut, chickenpox or are immunocompromised. The bacteria can be passed from person to person but this rarely happens. Caregivers are sometimes given a course of antibiotics to reduce the risk of developing the infection.

Facts and Statistics

  1. Keep in mind that this is a very serious illness but is also very rare.
  2. According to the Centers for Disease Control and Prevention, there are 500 -1500 cases per year in the United States.
  3. The bacteria, group A Strep, causing this serious infection is the same one that causes other minor infections like impetigo, pharyngitis and strep throat.
  4. The most common sites for necrotizing fasciitis are arms, legs and the abdominal wall.
  5. 1 in 4 cases of necrotizing fasciitis are fatal.

Symptoms to Watch For

The most important fact of which to be aware is how suddenly symptoms progress after they first begin, usually within 24 hours. The infection becomes critical and life and limb-threatening very quickly. Physical symptoms of developing necrotizing fasciitis are:

  • Pain, which is much more severe than would be expected from the infected wound
  • Redness and swelling at the infection site
  • Fever and chills
  • Nausea and vomiting
  • Diarrhea
  • Dizziness
  • Weakness
  • General malaise

Later developments include:

  • Gangrene resulting in limb amputation
  • Organ failure
  • Death

The Treatment

Early treatment is critical to the survival rate. Many patients are initially diagnosed based upon how quickly the infection is progressing. Patients become very ill very quickly.

Treating necrotizing fasciitis always requires hospitalization, usually in a critical care unit. What is the usual course of treatment?

  • High dose antibiotics are administered to treat the infection.
  • Surgery is almost always required to remove diseased tissue.
  • Supportive care for treatment of shock.
  • Careful evaluation for other developing complications.
  • Hyperbaric oxygen therapy is sometimes used to promote healing.

Further Prevention

Encourage patients to wash their hand often, keep all wounds, including cuts, scrapes, insect bites and burns, clean in order to prevent infection from developing. Patients should seek immediate medical attention if they develop rapidly progressing signs of infection. Again, necrotizing fasciitis is rare but requires early and aggressive medical intervention.

 

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